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44525 - SURFACE ANATOMY AS A GUIDE TO VERTEBRAL LEVEL FOR THORACIC EPIDURALS

¹ University of Calgary, Calgary, AB, Canada
² University of Calgary
³ University of Calgary
⁴ University of Calgary
⁵ University of Calgary

Abstract

INTRODUCTION: Precise placement of thoracic epidural catheters is required to provide postoperative analgesia (1) with minimal adverse effects. Previous research shows that anesthesiologists are inaccurate when using surface anatomy to locate vertebral levels (2–5). This study compares the accuracy of two different landmarks to identify the T7 spinous process.

METHODS: The protocol received local ethics committee approval. Two hundred and ten patients referred for chest radiography gave consent and were randomized to two groups. With the patients in anatomic position, one investigator identified and labeled the presumed T7 spinous process using either C7 (prominens) or the scapular tip as a surface landmark. A radiologist, blinded to the identification technique, reported the spinous process corresponding to the radio-opaque label. Marker positions were then compared using the Fisher exact test. The impact of patient characteristics (age, gender, body mass index (BMI), height, weight) were then examined according to accuracy of landmarking method.

RESULTS: Patient characteristics were similar between groups. The T7 spinous process was identified correctly 29% of the time with the C7 landmark and 10% with the scapular landmark (p<0.001) (Table 1). Accuracy improved for T7 +/– 1 level to 78% and 42% respectively. Errors were more common in the caudal direction. The C7 landmark was more accurate among those with a BMI < 25. In those with a BMI &#8805; 25 neither landmark resulted in high accuracy.

This Article Abstract Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Teoh, D. Articles by Smith, D. Search for Related Content PubMed Articles by Teoh, D. Articles by Smith, D.