Thoracic epidural catheter placement failure rate by contrast epidurography: a single-center retrospective study

Contrast epidurography is an objective and reliable imaging modality to confirm the appropriate placement of thoracic epidural catheters for postoperative analgesia. To date, no large studies have reported failure rates of catheter placement as confirmed by contrast epidurography, nor have they associated patient and procedural factors.

This was a single-center retrospective study analyzing failure rates and associated patient and procedural factors for thoracic epidural catheters placed using a conventional landmark-based technique and confirmed by contrast epidurography. All epidural contrast studies taken over a 5-year study period were analyzed along with potential predictors of failure, including patient age, sex, body mass index, a diagnosis of thoracic scoliosis, patient positioning, needle approach, training level of primary operator, and fellowship training of the supervising anesthesiologist.

1017 epidural contrast studies were included for analysis. The failure rate after initial catheter placement was 12.2%. For catheters placed as a second attempt to "rescue" a failed initial attempt, the failure rate was 24.0%. Multivariable logistic regression analysis showed a greater odds of failed placement associated with obesity compared with regular weight (adjusted OR (aOR): 1.9, 95% CI 1.12 to 3.3) and older age compared with age <55 (aOR for age 55-74: 2.78, 95% CI 1.39 to 6.21; aOR for age ≥75: 4.16, 95% CI 1.94 to 9.77).

Failure rates for thoracic epidural catheter placement as confirmed by contrast epidurography at a teaching institution are reported. Age≥55 and obesity are both associated with a greater odds of failed placement.