Comparison of median and paramedian technique of thoracic epidural anaesthesia in patients undergoing laparotomy under combined general and epidural anaesthesia – A prospective observational study

Abstract

Background and Aims: Most studies have found that lumbar epidural catheterisation is technically easier with a paramedian than median approach. There is scant literature comparing the two approaches to the epidural space in the mid-thoracic spine. This study aims to compare the median versus paramedian approaches in the location of epidural space in the T7–9 region in patients undergoing laparotomy under combined general and epidural anaesthesia. Methods: A prospective observational study was conducted after ethical approval and written informed consent on 70 patients undergoing major abdominal surgery. The patients received epidural analgesia either through a median or paramedian approach (Group M, n = 35 and Group P, n = 35). The primary objective was the incidence of successful epidural catheter placement in the first attempt. The secondary objectives were the overall success rate, the requirement of change of intervertebral space, approach or operator and complications associated with the procedure. Results: Sixty-seven patients were analysed. Epidural catheter was placed successfully in the first attempt in 40% of patients in Group M and 78.1% in Group P (P = 0.003). The overall success rate was 74.3% in Group M and 87.5% in Group P (P = 0.223). The number of attempts in Group M was more (one attempt 14, two 6, three 5 and four 1) as compared to Group P (one 25, two 2, three 1 and four 0) (P = 0.014). The incidence of complications was comparable between the groups. Conclusion: Epidural catheter insertion was technically easier in paramedian as compared to the median approach in T7–9 thoracic region with no difference in complications.

Keywords

• analgesia
• epidural
• median approach
• paramedian approach
• thoracic vertebrae