Ultrasound Imaging for Thoracic Epidural Insertion

Ultrasound imaging of the thoracic spine to guide epidural insertion. An extended video that includes a discussion of confirming epidural location, advancing and securing the catheter can be found at • Ultrasound Imaging for...
0:09 - Morphology of the thoracic spine
0:40 - Lumbar vs thoracic vertebra
1:11 - Transverse view on US
2:08 - Parasagittal oblique view on US
3:01 - How US imaging helps in epidural insertion
4:23 - Examples of difficult thoracic interspaces
5:01 - Importance of the lateral-to-medial angle
6:02 - Caudal-to-cranial needle trajectory
6:48 - Estimating needle insertion depth
8:05 - Video of thoracic epidural insertion
9:53 - Identifying intervertebral levels with US
10:31 - How to count down from the first rib

[@KiJinnChin]

0:09 - Morphology of the thoracic spine
0:40 - Lumbar vs thoracic vertebra
1:11 - Transverse view on US
2:08 - Parasagittal oblique view on US
3:01 - How US imaging helps in epidural insertion
4:23 - Examples of difficult thoracic interspaces
5:01 - Importance of the lateral-to-medial angle
6:02 - Caudal-to-cranial needle trajectory
6:48 - Estimating needle insertion depth
8:05 - Video of thoracic epidural insertion
9:53 - Identifying intervertebral levels with US
10:31 - How to count down from the first rib

[@oshabana]

Thanks alot for the great video!
After hitting the lamina at thoracic epidurals
How much should i withdraw the needle before directing it more cephalic?
Just a few mm,s or withdraw it till just before the skin?

[@KiJinnChin]

@@oshabana you should withdraw as much as is necessary to be able to change your angle WITHOUT exerting force that will bend your needle. Never bend any needle. You will probably find that you can make small angles of change without withdrawing too far; for larger angles of change, you will have to withdraw out of the muscle and make a new insertion track.

[@oshabana]

@@KiJinnChin thx alot sir!

[@MISSLOVELY_REE]

I need a shot in my back thoracic muscle its moving 🤷🏾‍♂️😔

[@imthanatmutant]

Everything in this video is really helpful. Thank you.

[@watanya1980]

Thank you Dr. Chinn!

[@anesblaze]

Very good video, thank you!

[@yasserelkenany1]

Great video thank you so much

[@tl854393]

Thank you so much.

[@streen2000]

Great video, thanks! Do you ever do these with real-time ultrasound?

[@KiJinnChin]

No, not personally. I find it too complex for a single operator. But this is the best description I have seen of it - www.ncbi.nlm.nih.gov/pubmed/29553999 and could be worth trying.

[@alexchan1361]

Is it midline approach?

[@KiJinnChin]

Not quite - strictly it is a paramedian approach - entry through the paramedian interlaminar window. But because we are so close to the spinous process, this is very similar to the trajectory that would result if you used the "midline" landmarkguided approach. The needle in the midline LMG approach usually passes just alongside the spinous processes, not strictly between them as they are so narrow.