Background and Aims: Thoracic epidural catheterisation by conventional surface landmark technique is challenging. The role of ultrasound (USG) in neuraxial blocks is emerging. In this single-centre, double blind, randomised trial, we aimed to study whether USG guidance improved the first attempt success rate of epidural catheterisation by senior anaesthesiologists’ residents. Methods: After institutional ethics committee approval, trial registration and informed consent, adult patients requiring epidural analgesia in the mid thoracic region (from fifth to eighth thoracic dermatomes) were randomised to either the clinical or USG arm. In the clinical arm, the entry point was marked using conventional surface landmarks. In the USG arm, the upper border of the lamina was visualised and marked 1–1.5 cm lateral to the spine. The senior resident blinded to the study arm used the marked point for insertion of the epidural needle. The number of passes and attempts needed for successful epidural catheterisation was noted. Results: The first attempt success rate was 65.1% in the USG group versus 50% in the clinical group ( P = 0.16). There was no difference in the number of passes and complications related to catheter insertion between the two groups. Conclusion: USG guidance did not significantly increase the first attempt success over the conventional landmark technique for mid-thoracic epidural catheterisation by senior residents.
Bakshi et al. (Thu,) studied this question.