• Sojin Shin, Jong-Hyuk Lee, Hyun-Jung Kwon, Ingon Lee, Dongseok Kim, Hakmoo Cho, Doo-Hwan Kim, and Sung-Moon Jeong.
• Department of Anesthesiology and Pain Medicine, Uijeongbu Eulji University Hospital, Uijeongbu, South Korea.
• Reg Anesth Pain Med. 2022 Dec 1; 47 (12): 738-743.

IntroductionReal-time ultrasound-guided thoracic epidural catheter placement (US-TECP) has been recently introduced. Patient's position is associated with the success of spine interventions; however, the effects of position on the outcome of the procedure remain unknown. We aimed to assess the clinical usefulness of patient positioning during real-time US-TECP.MethodsPatients were randomly assigned to the prone position group (group P) and sitting position group (group S). The primary outcome was needling time during the procedure. The secondary outcomes were time to mark space, total number of needle passes, number of skin punctures, first-pass success, final success, crossover success, and visibility of ultrasound (US) views. Global Rating Scale (GRS) score, Patient Comfort Scale score, procedural pain intensity, patient satisfaction, and procedure-related complications were also determined.ResultsSixty-four patients were included in this study. The needling time was significantly shorter in group P than in group S (36.5 (26.5-51.0) vs 59.5 (34.5-152.0) s, p<0.01). The numbers of needle passes and skin punctures were significantly lesser in group P than in group S. First-pass success was higher in group P than in group S. Group P had higher GRS compared with group S. The time to mark space, final success, US visibility score, Patient Comfort Scale score, procedural pain intensity, and patient satisfaction did not differ between the groups. One patient in group S developed a vasovagal reaction.DiscussionThis study shows that prone position may be preferred for real-time US-TECP, considering its better clinical usefulness.Trial Registration NumberKCT0005757.© American Society of Regional Anesthesia & Pain Medicine 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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