• Tatsuya Kunigo, Yusuke Yoshikawa, Shunichi Niki, Masahiro Ohtani, Mami Muraki, Asako Nitta, Yuki Ohsaki, Kanna Nagaishi, and Michiaki Yamakage.
• Department of Anesthesiology, Sapporo Medical University School of Medicine, 291 South 1 West 16, Chuo-ku, Sapporo-shi, Hokkaido 060-8543, Japan. Electronic address: tatsuya_9250@yahoo.co.jp.
• J Clin Anesth. 2025 Feb 1; 101: 111740111740.

Study ObjectiveWe developed an innovative method for ultrasound-assisted thoracic epidural catheter placement and assessed its potential to reduce procedural duration for trainees.DesignA cadaveric observational study and a clinical randomized controlled trial.SettingSapporo Medical University Hospital.PatientsA total of 52 adult patients scheduled for thoracic or abdominal surgery and four cadavers.InterventionsPatients were randomly assigned to either group receiving conventional palpation (conventional group) or combination of the ultrasound examination and conventional palpation (ultrasound group).MeasurementsThe primary outcome was total procedure time (sum of skin marking time and needling time) by trainees. The secondary outcomes were (1) skin marking time, (2) needling time, (3) multiple skin punctures, (4) needle redirection, (5) complications, and (6) failed cases.Main ResultsThrough dissection of four cadavers, the most dorsal site of the transverse process root was identifiable by ultrasound and the reliable indicator of the interlaminar space. We devised ultrasound-assisted middle thoracic epidural catheter placement utilizing the most dorsal sites of bilateral transverse process roots as anatomical landmarks. Trainees in the ultrasound group had significantly longer skin marking time and significantly shorter needling time than those in the conventional group (107 [87-158] vs 46 s [34-54] s, p < 0.001 and 197 [156-328] vs 341 [303-488] s, p = 0.003). Consequently, there was no significant difference between the two groups in total procedure time (326 [263-467] s vs 391 [354-533] s, p = 0.167). Moreover, the probability of trainee failure in epidural anesthesia was significantly lower in the ultrasound group (2/26 [17.7 %] vs 10/26 [38.5 %], p = 0.019).ConclusionsOur novel technique for thoracic epidural catheter placement resulted in expedited needling and enhanced success rates among trainees, although there was no significant difference between total procedure time when using ultrasound guidance and that when using conventional palpation.Copyright © 2024. Published by Elsevier Inc.

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