Ultrasound-assisted Thoracic Epidural Catheter Insertion
Evaluation of the Accuracy of Real-time Ultrasound-assisted Thoracic Epidural Catheter Insertion: a Pilot Study
調査の概要
詳細な説明
Thoracic epidural anesthesia has been associated with reduced acute postoperative pain for a wide variety of surgical procedures. It has also been associated with reductions in perioperative cardiac stress, chronic post-thoracotomy pain, and improvements in postoperative pulmonary function. Although a variety of methods can be used to confirm the position of the epidural needle in the epidural space, a blind technique and fluoroscopic guided approach are a widely used method. A thoracic epidural block is a relatively more difficult procedure than procedures used in other regions, because the spinous process of the thoracic vertebra is longer than that of the lumbar vertebra, and the area through which the needle can approach the epidural space is relatively smaller due to an acute angle and larger distance between the skin and the epidural space. Therefore, the success rate of thoracic epidural intervention is only about 68% under a blind technique due to inadequate position of the needle tip, misplacement, occlusion, and migration of the catheter.
Although fluoroscopic guided thoracic epidural intervention is the safest and most accurate method to identify the correct anatomical structures and confirm the epidural space with contrast medium, its use is limited because of the difficulty of using fluoroscope and the burden of radiation exposure. As the use of ultrasound has become popularized and universal, it has been widely used in regional anesthesia and analgesia, has continuously replaced the modality such as a blind technique and fluoroscopic guidance. Ultrasound-guided thoracic epidural catheter insertion was also recently investigated, and then it was conducted successfully in 15 cases of thoracic and upper abdominal surgery. Moreover, it showed several advantages including lowering the number of needle passes and increasing the success rate. However, it has not yet been studied how accurately the catheter is located in the thoracic epidural space during thoracic epidural catheter insertion using real-time ultrasound. Although it is possible to speculate the success of the thoracic epidural catheterization clinically, the identification of the location of the catheter is only possible under fluoroscopic guidance. Therefore, in the present study, we aimed to confirm the success rate of ultrasound-guided thoracic epidural catheter insertion, using fluoroscopy with contrast medium.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
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Seoul、大韓民国、05505
- Asan Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- Patients who will undergo upper abdomen or thoracic surgery
- Scheduled for thoracic epidural catheter insertion
- 20 ≤ age <80
- When obtaining informed consent voluntarily
Exclusion Criteria:
- Allergy to local anesthetics and contrast dye, and steroid
- Use of anticoagulants or antiplatelet medication, coagulopathy
- Infection at the insertion site
- Neurological or psychiatric disorders
- Prior spine instrumentation
- Pregnancy
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:診断
- 割り当て:なし
- 介入モデル:単一グループの割り当て
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:Ultrasound-guided TECI
After assessment of the epidural space using the loss of resistance technique with saline under ultrasound guidance, fluoroscopic views will be obtained to confirm which the catheter tip is located in the epidural space or not.
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When performing an ultrasound-guided thoracic epidural catheter insertion (TECI), an 18-gauge Tuohy needle will be used for interlaminar epidural access.
All procedures will be performed with a paramedian approach under ultrasound-guidance and using the loss of resistance technique with saline.
If the needle is deemed to be in the epidural space when the loss of resistance occurred, fluoroscopic views will be obtained to confirm which the catheter tip is located in the epidural space or not.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Success rate of ultrasound-guided thoracic epidural catheter insertion
時間枠:on the day of the procedure
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Confirmation success of ultrasound-guided thoracic epidural catheter insertion using fluoroscopic images; success means that the catheter tip is located in the epidural space.
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on the day of the procedure
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二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
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Number of skin punctures
時間枠:on the day of the procedure
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complete needle withdrawal from the skin and reinsertion at a new location
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on the day of the procedure
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Number of needle passes
時間枠:on the day of the procedure
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First needle pass + additional needle passes (the needle returned to a plane perpendicular to the skin before reinsertion.
Needle tip maneuvers toward the midline and cephalad were considered standard needle walking technique and were counted as a single pass)
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on the day of the procedure
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First attempt success rate
時間枠:on the day of the procedure
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only first needle pass and first skin puncture
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on the day of the procedure
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協力者と研究者
スポンサー
捜査官
- 主任研究者:Jong-Hyuk Lee, MD、Asan Medical Center
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
Ultrasound-guided TECIの臨床試験
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Zuyderland Medisch Centrum積極的、募集していない上肢骨折 | 橈骨遠位端骨折 | 上腕骨の近位端の骨折 | 上肢骨折オランダ
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Orthofix s.r.l.完了関節疾患 | ゲン・ヴァルム | Genu Valgum | 膝の変形 | 足首の変形 | 長さの不平等、脚 | 不一致の長さ;先天性 | 四肢の変形イタリア
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Academisch Medisch Centrum - Universiteit van Amsterdam...完了
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Piazza della Vittoria 14 Studio Medico - Ginecologia...募集
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Helse Nord-Trøndelag HFNorwegian University of Science and Technology; St. Olavs Hospital完了
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Icahn School of Medicine at Mount SinaiPhilips Healthcareわからない