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Updated: Jun 9, 2026
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Experience with 724 epidurograms for epidural catheter placement in pediatric anesthesia
Andreas H Taenzer1, Cantwell Clark, W Daniel Kovarik
1Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Children's Hospital at Dartmouth, Lebanon, NH 03756, USA. Andreas.H.Taenzer@hitchcock.org
Insights
Epidural catheter placement in children is confirmed effectively using epidurography. This imaging technique ensures correct placement, identifies incorrect spaces, and predicts analgesic coverage, improving patient safety.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Epidural analgesia with continuous catheters is common in children.
- Correct placement is crucial due to risks associated with malpositioning under anesthesia.
- Confirmation at insertion is ideal to prevent complications.
Purpose of the Study:
- To evaluate the efficacy of epidurography in confirming epidural catheter placement in pediatric patients.
- To identify the incidence of misplacements using routine epidurography.
Main Methods:
- A retrospective analysis of data from two academic teaching hospitals.
- Combined experience from regional anesthesia databases.
- Screening for unrecognized epidural catheter misplacements via epidurography.
Main Results:
- A total of 724 epidurograms were analyzed.
- 12 unexpected misplacements were detected (1.6%): 4 intrathecal, 3 intravenous, 3 intraperitoneal.
- Catheter types included caudal (45.8%), lumbar (9.6%), and thoracic (32.3%).
Conclusions:
- Epidurography is highly effective in confirming epidural catheter placement.
- It uniquely confirms correct placement, rules out incorrect anatomical spaces, and predicts analgesic coverage.
- Routine epidurography enhances patient safety in pediatric epidural analgesia.
Introduction:
Epidural analgesia via continuous catheters, placed either via the caudal approach or directly at the desired level, is a commonly used technique in children. It is particularly important that these catheters are placed correctly because most are placed under general anesthesia and require deep sedation or repeat general anesthesia for replacement if malfunctioning. Ideally, correct placement should be confirmed at the time of insertion.
Methods:
We combined the experience of 2 academic teaching hospitals that both perform routine epidurography for the placement of epidural catheters in children. The data from 2 quality assurance regional anesthesia databases were screened for unrecognized misplacements of epidural catheters.
Results:
Of a total of 724 epidurograms, 45.8% were caudal catheters, 9.6% were lumbar catheters, and 32.3% were thoracic catheters. Epidurograms detected 12 (1.6%) unexpected misplacements: 4 were intrathecal, 3 were intravenous, and 3 were intraperitoneal.
Conclusions:
Our experiments suggest that confirmation of epidural catheter placement via epidurogram is highly efficacious. Epidurography is the only currently available technique that accomplishes all of the following: (a) confirms correct placement, (b) rules out incorrect anatomic space, and (c) predicts analgesic coverage.
