TY - JOUR
T1 - Relationship between epidural catheter migration beneath the skin and subcutaneous fat thickness assessed using postoperative CT imaging
T2 - a retrospective cross-sectional study
AU - Sakamoto, Natsumi
AU - Matsuo, Mitsuhiro
AU - Takazawa, Tomonori
N1 - Publisher Copyright:
© The Author(s) under exclusive licence to Japanese Society of Anesthesiologists 2024.
PY - 2024/10
Y1 - 2024/10
N2 - Purpose: The causes of epidural catheter migration beneath the skin have not been previously investigated. We hypothesized that greater subcutaneous fat thickness might be associated with increased catheter migration beneath the skin. Methods: We conducted a retrospective cross-sectional study of patients who had undergone combined general and epidural anesthesia, selecting individuals who received thoracic and abdominal CT scans within the first 5 postoperative days. Needle depth was defined as the distance from the needle tip to the skin surface when the anesthesiologist determined that the needle tip had reached the epidural space. We measured the length of the epidural catheter from the skin surface to the epidural space (catheter length), and subcutaneous fat thickness (fat thickness) using CT imaging. Migration distance was calculated by subtracting needle depth from catheter length. Results: We analyzed 127 patients (72 males), all undergoing epidural catheter insertion in the left lateral decubitus position via a paramedian approach. The median age of the patients was 71 years. Epidural catheters were postoperatively found to substantially curve beneath the skin. Regression analysis revealed no significant influence of fat thickness on catheter length (regression coefficient 0.10, 95% confidence interval [CI]: − 0.17, 0.38). However, it indicated a positive correlation between fat thickness and needle depth (regression coefficient 0.50, 95% CI: 0.30, 0.70), and a negative correlation between fat thickness and migration distance (regression coefficient − 0.40, 95% CI: − 0.65, − 0.14). Conclusion: We found a negative correlation between epidural catheter migration beneath the skin and subcutaneous fat thickness. Anesthesiologists should be aware of the possibility of substantial subcutaneous curving of the catheter, especially in patients with scant subcutaneous fat.
AB - Purpose: The causes of epidural catheter migration beneath the skin have not been previously investigated. We hypothesized that greater subcutaneous fat thickness might be associated with increased catheter migration beneath the skin. Methods: We conducted a retrospective cross-sectional study of patients who had undergone combined general and epidural anesthesia, selecting individuals who received thoracic and abdominal CT scans within the first 5 postoperative days. Needle depth was defined as the distance from the needle tip to the skin surface when the anesthesiologist determined that the needle tip had reached the epidural space. We measured the length of the epidural catheter from the skin surface to the epidural space (catheter length), and subcutaneous fat thickness (fat thickness) using CT imaging. Migration distance was calculated by subtracting needle depth from catheter length. Results: We analyzed 127 patients (72 males), all undergoing epidural catheter insertion in the left lateral decubitus position via a paramedian approach. The median age of the patients was 71 years. Epidural catheters were postoperatively found to substantially curve beneath the skin. Regression analysis revealed no significant influence of fat thickness on catheter length (regression coefficient 0.10, 95% confidence interval [CI]: − 0.17, 0.38). However, it indicated a positive correlation between fat thickness and needle depth (regression coefficient 0.50, 95% CI: 0.30, 0.70), and a negative correlation between fat thickness and migration distance (regression coefficient − 0.40, 95% CI: − 0.65, − 0.14). Conclusion: We found a negative correlation between epidural catheter migration beneath the skin and subcutaneous fat thickness. Anesthesiologists should be aware of the possibility of substantial subcutaneous curving of the catheter, especially in patients with scant subcutaneous fat.
KW - Epidural anesthesia
KW - Epidural space
KW - Neuraxial anesthesia
KW - Paramedian approach
KW - Synapse vincent
UR - http://www.scopus.com/inward/record.url?scp=85198110338&partnerID=8YFLogxK
U2 - 10.1007/s00540-024-03374-w
DO - 10.1007/s00540-024-03374-w
M3 - 学術論文
C2 - 38990343
AN - SCOPUS:85198110338
SN - 0913-8668
VL - 38
SP - 674
EP - 680
JO - Journal of Anesthesia
JF - Journal of Anesthesia
IS - 5
ER -