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Predictors of Epidural Depth in Percutaneous Nephrolithotomy and Model Development

13 luglio 2026 aggiornato da: Hongbo Zheng, Tongji Hospital

Analysis of Factors Influencing Epidural Depth in Patients Undergoing Percutaneous Nephrolithotomy and Development of a Predictive Model

Accurate estimation of epidural depth is critical for safe epidural anesthesia during percutaneous nephrolithotomy (PCNL). Although various imaging modalities can predict epidural depth, they increase healthcare burden and are not always feasible in emergency or bedside settings. Identifying simple, easily obtainable clinical parameters-such as sex, age, and body mass index (BMI)-for predicting epidural depth has become a research priority. However, systematic investigations specifically targeting the Chinese population remain scarce. This retrospective study aims to identify independent factors influencing epidural depth in PCNL patients and to develop simple, level-specific predictive models for different puncture sites, thereby providing a practical reference for clinical epidural anesthesia.

Panoramica dello studio

Stato

Non ancora reclutamento

Condizioni

Descrizione dettagliata

Percutaneous nephrolithotomy (PCNL) is the standard minimally invasive surgical procedure for removal of kidney stones larger than 2 cm and is established as the gold standard for the management of complex renal calculi. This procedure may be performed under either general anesthesia or regional anesthesia, including epidural or spinal anesthesia. Accumulating meta-analyses have demonstrated that, compared with general anesthesia, regional anesthesia is associated with reduced postoperative pain scores and lower total hospital costs, without compromising the stone-free rate. Furthermore, in awake patients undergoing regional anesthesia, respiratory movements may generate a so-called "respiratory-synchronous stone fragmentation effect," which facilitates the expulsion of stone debris.

Successful epidural anesthesia relies critically on accurate identification of the epidural space and precise control of puncture depth. Insufficient puncture depth may result in improper catheter placement and subsequent block failure, whereas excessive puncture depth increases the risk of dural puncture, leading to cerebrospinal fluid leakage and post-dural puncture headache. In severe cases, inadvertent injection of a large dose of local anesthetics into the subarachnoid space can cause life-threatening cardiovascular and respiratory depression. Therefore, preprocedural estimation of the skin-to-epidural space distance is of considerable clinical importance.

Although racial differences in epidural depth have been reported, systematic investigations specifically targeting the Chinese population remain scarce. Various imaging modalities, including computed tomography, magnetic resonance imaging, and ultrasound, can be used to predict epidural depth. However, these examinations increase healthcare burden and are not always feasible in emergency or bedside settings. Consequently, identifying simple, easily obtainable clinical parameters-such as sex, age, and body mass index (BMI)-for predicting epidural depth has become a research priority.

In this context, the present study aimed to identify factors influencing epidural depth through a retrospective analysis of clinical data from PCNL patients and to develop simple, level-specific predictive models for different puncture sites, thereby providing a practical reference for clinical epidural anesthesia.

Tipo di studio

Osservativo

Iscrizione (Stimato)

3278

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Nome: Hongbo Zheng, MM
Numero di telefono: +8618040544926
Email: zheng1283@163.com

Backup dei contatti dello studio

Nome: Hong Chen Chen, MM
Numero di telefono: 17786127071
Email: 2010tj0573@hust.edu.cn

Luoghi di studio

Cina
- Hubei
  - Wuhan, Hubei, Cina, 430030
    - Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology
    - Contatto:
      
      Hongbo Zheng, MM
      
      Numero di telefono: +8618040544926
      
      Email: zheng1283@163.com
    - Contatto:
      
      Email: zheng1283@163.com

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

Adulto
Adulto più anziano

Accetta volontari sani

Metodo di campionamento

Campione non probabilistico

Popolazione di studio

Adult patients who underwent PCNL under continuous epidural anesthesia between January 2014 and December 2025. All patients were treated at a single academic medical center. Data were extracted from electronic medical records and anesthesia records.

Descrizione

Inclusion Criteria:

Age ≥ 18 years
Successful epidural puncture and catheter placement using the midline approach
Clear documentation of puncture level and puncture depth in the anesthesia record

Exclusion Criteria:

Dural puncture during anesthesia (including those who subsequently had a successful repuncture)
Use of the paramedian approach for epidural puncture
Uncertain epidural anesthesia effect requiring combined general anesthesia
Incomplete clinical data

Piano di studio

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Dettagli di progettazione

Coorti e interventi

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T11-T12 On operating room admission, after providing written informed consent for anesthesia, patients underwent standard monitoring (ECG, NIBP, pulse oximetry). Baseline demographic and anthropometric data, including hospital admission ID, sex, height, and weight, were recorded, and body mass index (BMI) was calculated. After positioning in the lateral decubitus position, the T11-T12 interspace was selected for puncture using a midline approach, and the loss-of-resistance technique confirmed epidural space entry. Puncture depth (skin-to-epidural space) was recorded from needle shaft markings to the nearest 0.1 cm.
T12-L1 On operating room admission, after providing written informed consent for anesthesia, patients underwent standard monitoring (ECG, NIBP, pulse oximetry). Baseline demographic and anthropometric data, including hospital admission ID, sex, height, and weight, were recorded, and body mass index (BMI) was calculated. After positioning in the lateral decubitus position, the T12-L1 interspace was selected for puncture using a midline approach, and the loss-of-resistance technique confirmed epidural space entry. Puncture depth (skin-to-epidural space) was recorded from needle shaft markings to the nearest 0.1 cm.
L1-L2 On operating room admission, after providing written informed consent for anesthesia, patients underwent standard monitoring (ECG, NIBP, pulse oximetry). Baseline demographic and anthropometric data, including hospital admission ID, sex, height, and weight, were recorded, and body mass index (BMI) was calculated. After positioning in the lateral decubitus position, the L1-L2 interspace was selected for puncture using a midline approach, and the loss-of-resistance technique confirmed epidural space entry. Puncture depth (skin-to-epidural space) was recorded from needle shaft markings to the nearest 0.1 cm.
L2-L3 On operating room admission, after providing written informed consent for anesthesia, patients underwent standard monitoring (ECG, NIBP, pulse oximetry). Baseline demographic and anthropometric data, including hospital admission ID, sex, height, and weight, were recorded, and body mass index (BMI) was calculated. After positioning in the lateral decubitus position, the L2-L3 interspace was selected for puncture using a midline approach, and the loss-of-resistance technique confirmed epidural space entry. Puncture depth (skin-to-epidural space) was recorded from needle shaft markings to the nearest 0.1 cm.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato	Misura Descrizione	Lasso di tempo
Epidural depth Lasso di tempo: Perioperative/Periprocedural	Epidural depth, defined as the vertical distance from the skin surface to the epidural space measured at the time of puncture using the loss-of-resistance technique via the midline approach. Depth was recorded from the needle shaft markings to the nearest 0.1 cm.	Perioperative/Periprocedural

Misure di risultato secondarie

Misura del risultato	Misura Descrizione	Lasso di tempo
Adjusted R² Lasso di tempo: through study completion, an average of 1 month	The coefficient of determination adjusted for the number of predictors in the model, reflecting the proportion of variance in epidural depth explained by the predictive model at each puncture level. Higher values indicate better model fit.	through study completion, an average of 1 month
Root mean square error (RMSE) Lasso di tempo: through study completion, an average of 1 month	The square root of the average squared difference between the model-predicted epidural depth and the actual measured depth, expressed in cm. Lower values indicate better predictive accuracy of the model at each puncture level.	through study completion, an average of 1 month

Collaboratori e investigatori

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Sponsor

Tongji Hospital

Investigatori

Investigatore principale: Hongbo Zheng, MM, Tongji Hospital

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Studia le date principali

Inizio studio (Stimato)

30 giugno 2026

Completamento primario (Stimato)

31 agosto 2026

Completamento dello studio (Stimato)

31 agosto 2026

Date di iscrizione allo studio

Primo inviato

5 luglio 2026

Primo inviato che soddisfa i criteri di controllo qualità

5 luglio 2026

Primo Inserito (Effettivo)

10 luglio 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

16 luglio 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

13 luglio 2026

Ultimo verificato

1 luglio 2026

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EDPN

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Individual participant data that underlie the results reported in this article, after deidentification (text, tables,figures, and appendices).

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Immediately followingpublication. No end date.

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Anyone who wishes to access the data.

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STUDIO_PROTOCOLLO
LINFA

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