Target-level epidural catheter placement in lower thoracic spine using preprocedural ultrasound marking: A prospective observational study
Related Experiment Video
Updated: Oct 31, 2026
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Momoko Sasaki1, Yuya Murata1, Tetsuya Kodaira1
1Department of Anesthesiology, University of Tsukuba Hospital, Ibaraki, Japan.
Background:
Accurate insertion of catheters into the target intervertebral level is essential for effective epidural anesthesia. However, conventional palpation-based methods are often unreliable, resulting in unintended motor weakness of the lower limbs when insertion is performed at the lower thoracic level. In this study, we evaluated the accuracy of placing an epidural catheter at the target intervertebral level in the lower thoracic spine using preprocedural ultrasound marking.
Methods:
In this prospective observational study, we enrolled 40 adults undergoing elective surgery with planned lower thoracic epidural anesthesia. After identifying the spinal level using ultrasound and marking the spinous and transverse processes as landmarks, the epidural catheter was placed at the target level. Postoperative radiographs were used to confirm the actual placement level. Accuracy was assessed based on whether the level at which the epidural catheter was actually placed matched the target intervertebral level.
Results:
Of the 40 patients, data of 37 were included in the final analysis. The accuracy rate relative to the target intervertebral level was 89.2% (33/37; 95% confidence interval: 74.6-97.0%). No major misplacements (≧2 interspaces) were observed.
Conclusion:
In the lower thoracic spine, the use of preprocedural ultrasound marking enabled highly accurate placement of epidural catheters at the target intervertebral level.
