• Izumi Kawagoe, Keiko Tajima, Masanori Kanai, and Hiromasa Mitsuhata.
• Department of Anesthesiology and Pain Medicine, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo.
• Masui. 2009 Jun 1;58(6):692-9.

BackgroundEpidural catheter insertion is a common procedure for gynecological surgeries. Epidural puncture is usually performed according to the anatomical landmarks without radiographic means. The aim of his study was to confirm the actual level of puncture, and the distance as well as the direction of epidural catheters threaded.MethodsSeventy-seven female patients receiving epidural anesthesia were enrolled. Epidural catheter was inserted from T12-L1 intervertebral space in cephalad direction for the length of 7 cm. The catheter was confirmed with postoperative plain X-P using picture archiving communication system. The intended direction and length were compared with the actual data. In addition, we retrospectively analyzed the factors including the performers (resident vs. specialist), the approaches of puncture (median vs. paramedian), and patient physical factors (age, height, body weight, and BMI).ResultsOf the catheters 54.6% was inserted from T12-L1, and 74% of them were advanced in cephalad direction. Of the tip of the catheter 71.4% stayed within one vertebra from the puncture level. The puncture accuracy, the frequency of catheter threaded over one vertebra, and the frequency of catheters threaded in cephalad direction did not differ significantly among performers, approaches and patients physical factors.ConclusionsOnly 11.7% of the catheters were actually inserted from T12-L1 and advanced in cephalad direction over one vertebra as we had intended.

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