Utility of longitudinal paramedian view of ultrasound imaging for middle thoracic epidural anesthesia in children

Purpose The risk of nerve injury for pediatric thoracic epidural block increases stress for anesthesiologists. The purpose of this study was to investigate the usefulness of longitudinal ultrasound imaging for thoracic epidural block (T5-T6 or T6-T7) in anesthetized children scheduled for the Nuss procedure. Methods Neuraxial structure in the longitudinal paramedian section was observed using ultrasound imaging before epidural puncture (US group, n = 10). In the control group, usual epidural block without ultrasound was performed. Attempts were made to observe epidural catheterization in ultrasound imaging in three cases. Results Patient age ranged from 5 to 7 years. Time for epidural block in the US group [100 (77-116) s; median value (95% confidence interval)] was significantly shorter than that in the control group [165 (130-206) s; P = 0.001]. The difficulty score was significantly lower in the US group than in the control group (P <0.001). Epidural catheterization was observed in all three cases in which the catheter manipulated the dura mater ventrally. There was a high correlation (r = 0.98, P <0.001) between needle depth and ultrasound estimation of the skin-dura distance in the US group. Conclusion We concluded that longitudinal paramedian ultrasound imaging could reduce performance time and the difficulty for anesthesiologists during epidural block.