Abstract
PurposeTo investigate the paths of thoracic epidural catheters in children, this retrospective study was performed.MethodsWe investigated 73 children aged 4 to 12 (mean ± SD 7.8 ± 2.3) years, who underwent the Nuss procedure for pectus excavatum repair under combined general and epidural anesthesia over a 5-year period at Tokyo Metropolitan Police Hospital. Following induction of general anesthesia, we inserted a radiopaque epidural catheter via the T5/6 or T6/7 interspace and advanced for 5 cm cephalad in the thoracic epidural space. We evaluated the paths of the epidural catheters on plain chest radiographs after surgery.ResultsThe median level for the catheter tip location was T3 (range C6–T7), while the median number of vertebrae crossed by the catheter tips was 2.5. In most children, the catheters advanced straight for the first 2–3 cm (1–1.5 vertebrae) in the thoracic epidural space. However, they continued to advance straight in only 25 children, while they exhibited curved or coiled paths in the remaining 48. The catheter tips were located at higher levels in children with straight epidural catheter paths [median (range) T2 (C6–T4)] than in those with curved or coiled paths after the initial 2–3 cm [median (range) T4 (T2–T7)] (p < 0.0001).ConclusionsOur findings indicate that the course of epidural catheters in children is unpredictable after the first 2–3 cm in the thoracic epidural space. Clinicians should be aware of such findings, although further studies are required for confirmation.
Highlights
The Nuss procedure for the repair of pectus excavatum in children involves thoracoscopy-guided placement of one to three steel bars behind the sternum and ribs through small incisions placed on both sides of the chest [1]
Linear regression analyses revealed that the skin-to-epidural space distance (SED; cm) correlated with the patient’s age (r = 0.48, p < 0.0001), body height (BH; cm; r = 0.51, p < 0.0001), and body weight (BW; kg; r = 0.48, p < 0.0001)
M:F Age, mean ± SD Body height, mean ± SD Body weight, mean ± SD, Intended insertion points Median [quartiles] Actual skin insertion points Median [quartiles] Actual epidural space insertion points Median [quartiles] Catheter direction immediately after entry in the epidural space Catheter tip direction Catheter tip position Median [quartiles] Number of vertebrae crossed by catheter tips
Summary
The Nuss procedure for the repair of pectus excavatum in children involves thoracoscopy-guided placement of one to three steel bars behind the sternum and ribs through small incisions placed on both sides of the chest [1]. This procedure is categorized as a minimally invasive procedure, postoperative pain is significant because of forceful distortion of bony structures [1]. For successful epidural catheterization in children, adequate knowledge regarding the anatomy of the posterior compartment of the epidural space is essential. At the lumbar and lower thoracic levels in adults, posterior epidural fat is discontinuous between adjacent vertebral segments and is separated by areas of contact between the
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