Acoustic puncture assist device versus ultrasound imaging technique for thoracic epidural space identification in obese patients

Abstract

Introduction Newer techniques have been used lately such as the ultrasonography (US) and the acoustic puncture assist device (APAD) to identify the epidural space (EDS). The difference between using these techniques in obese patients has not been studied enough yet. The primary aim of this study is to evaluate the ease of placement of thoracic epidural catheter in obese patients using either APAD versus US imaging assisted technique. The secondary aim is to compare the incidence of complications between both techniques. Patients and methods The institutional review board at the University of Alexandria approved the study protocol. One hundred obese patients (BMI >30 kg/m2) were randomly enrolled into one of the two study groups. The placement of thoracic epidural catheter was done using an US-assisted technique in cases of group I, while epidural catheter was inserted into the thoracic EDS using APAD in group II patients. Results First attempt success rate for EDS localization was higher in group II (APAD) as compared with group I (US group) (83 vs. 79%), but there was no significant statistical difference between both groups (P=0.461). Mean time for EDS localization was statistically significantly longer in group I (US-guided group) than in group II (APAD) (78.44±23.6 vs. 58.78±22.2 s; P Conclusion The previous findings of the shorter time of EDS localization and more patient comfort in APAD-guided epidural analgesia than those of US-guided technique has ended in the conclusion that the use of APAD for thoracic epidural anesthesia in obese patients is a better choice than using US.