TOPLINE

Among patients scheduled for abdominal surgery who required thoracic epidural anesthesia, real-time ultrasound guidance was associated with a higher first-pass success rate for lower thoracic epidural puncture than ultrasound-guided marking performed before the procedure alone.

METHODOLOGY

• Researchers conducted a superiority randomized controlled trial in Japan from August to November 2025 to compare preprocedural ultrasound with real-time ultrasound guidance in 64 adult patients scheduled for abdominal surgery requiring thoracic epidural anesthesia at T8-T12.
• All patients underwent preprocedural ultrasound to identify and mark the target intervertebral level. They were randomly assigned to receive either real-time ultrasound guidance during needle advancement or preprocedural ultrasound-guided marking alone (performed before needle insertion).
• All procedures were performed by a single experienced anesthetist using an 18-gauge Tuohy needle and a spring-loaded syringe, with patients lying on their left side.
• The primary outcome was first-pass success, defined as successful epidural catheter placement with a single skin puncture and no additional passes, as assessed by two experienced anesthetists.
• The secondary outcomes were the time taken for the procedure, the number of passes, the number of punctures, ultrasound confirmation of catheter placement, and the incidence of complications after surgery.

TAKEAWAY

• The first-pass success rate was significantly lower in the preprocedural ultrasound group than in the real-time ultrasound group (P = .008).
• Real-time ultrasound guidance was associated with a higher first-pass success rate (adjusted odds ratio, 5.1; P = .007).
• The median number of passes was lower in the real-time group than in the preprocedural group (P = .002). The procedure time did not differ significantly between the two groups.
• At 2 weeks after surgery, neither group had severe complications such as epidural hematoma, epidural abscess, or dural puncture. However, two patients in each group experienced transient limb paraesthesia.

IN PRACTICE

"In [the] study, ultrasound confirmation following air injection was feasible in the majority of patients. [The] findings suggest that ultrasound may serve as a practical and widely applicable method for objective confirmation of epidural catheter placement in clinical settings," the researchers wrote. "By simplifying the procedure and enhancing precision, this technique may promote broader adoption of ultrasound guidance in routine epidural anaesthesia practice," they added.

SOURCE

The study was led by Shosaburo Jotaki, of the Department of Anesthesiology at Omuta City Hospital, Omuta, Japan. It was published online on September 01 in Anaesthesia.

LIMITATIONS

All procedures were performed by a single experienced anesthetist, so the results might not apply to others with different levels of experience. The study did not assess analgesic efficacy or patient-centered outcomes. A difference in methodology between groups regarding puncture side in the lateral decubitus position may have affected the performance of the procedure.

DISCLOSURES

No specific funding was reported. The authors declared no relevant competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.