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Which is a better position for insertion of a high thoracic epidural catheter: sitting or lateral decubitus?

Masatoshi Nishi1, Ai Usukaura, Yoko Kidani

  • 1Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan. makun0119jp@ybb.ne.jp <makun0119jp@ybb.ne.jp>

Journal of Cardiothoracic and Vascular Anesthesia
|October 7, 2006
PubMed

Insights

For high thoracic epidural anesthesia, the lateral decubitus position is recommended over the sitting position to prevent vagal reflexes during catheterization in patients undergoing off-pump coronary artery bypass graft surgery.

Area of Science:

  • Anesthesiology
  • Cardiovascular Surgery
  • Neurosurgery

Background:

  • High thoracic epidural anesthesia is utilized for off-pump coronary artery bypass graft (OPCAB) surgery.
  • Patient positioning during epidural catheterization can influence safety and efficacy.

Purpose of the Study:

  • To compare the safety and success rates of high thoracic epidural catheter placement in the sitting versus lateral decubitus positions.
  • To evaluate adverse events, insertion time, and accuracy between the two positions.

Main Methods:

  • Prospective randomized study involving 41 patients undergoing OPCAB surgery.
  • Epidural catheter insertion was performed in either the sitting or lateral decubitus position.
  • Comparison of success rates, adverse events, insertion time, and accuracy.

Main Results:

  • Success rates were comparable between the sitting and lateral decubitus groups.
  • A significantly higher incidence of vagal reflexes occurred in the sitting group (20%, p < 0.05).
  • Catheter insertion time was shorter in the sitting group (p < 0.05), with comparable accuracy at the first attempt.

Conclusions:

  • The lateral decubitus position is recommended for high thoracic epidural catheterization in OPCAB patients.
  • This positioning may help mitigate the risk of vagal reflexes.
  • The study highlights the importance of patient positioning in regional anesthesia.
Abstract

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