[Preoperative epidural catheterization under radiographic monitoring]

We reviewed the indications for and features of preoperative epidural catheterization under radiographic monitoring. This technique allows easy epidural catheterization and achieves reliable effects for postoperative analgesia, reducing the burden on patients, particularly those with morbid obesity, strong transformation of spine or unilateral operations such as total knee arthroplasty or pneumectomy. Standard methods are as follows: (1) the patient is placed in a prone position on the fluoroscopic table; and (2) the operator usually stands to the left of the patient. First, a 23 G, long needle is introduced for local anesthesia and to confirm depth and angle from the skin to the basal part of the spinous process. An 18 G Tuohy needle is advanced to the epidural space under real-time radiographic monitoring. It is important that the operator advances the catheter to the epidural space on the operative side (right, left or middle). Finally, confirmation is made under radiographic imaging that the catheter remains at the back of the epidural space. Preoperative epidural catheterization under radiographic monitoring is a safe, reliable, and educational method.