Abstract
To the Editor, Placement of a thoracic epidural requires a high level of skill and is a challenging procedure to perform. In adults, the effectiveness of ultrasound guidance for thoracic epidural placement is limited as the bony anatomy of this region restricts and obstructs ultrasound visualization of the epidural space. For this reason, anesthesiologists continue to rely on a tactile approach with either a loss of resistance method or a hanging drop technique, both of which result in challenging needle insertion due to the angle required to access the thoracic epidural space. Most anesthesiologists find the paramedian approach to be the most effective technique for thoracic epidural placement. The technique involves the following steps:
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