Thoracic Epidural Analgesia: Technique

[@hanagasme3259]

It is the best channel for giving info about anesthesia Thanks alot 😊

[@haroldmarks-fr6vu]

❤your empathy and compassion shows! Thank you.

[@Scottgas3]

I'm retired, but a few years ago I was the go to person in my group whenever a patient with rib fractures was seen in the ER. My trauma surgeon colleague was very impressed with the efficacy of intracoastal nerve blocks. Most patients do not have as extensive injuries as the patient in this case study. The ides was for treating the patient with intercostal nerve blocks so they could be sent home, only to return the next day for a repeat if they needed it. Interestingly, I tried a few with Exparel, but the duration wasn't as long as I had hoped. I think, however that this blocks can be a useful alternative to thoracic epidural where the injury is more limited. ICB's can also be used to treat shingles.

[@akshayuttarwar3240]

It's good to see clinical video on such important topic. Thank you

[@nysoravideo]

Glad it was helpful!

[@KapCityRunner]

As always, excellent quality videos

[@fredjones554]

Many thanks for these videos. Excellent teaching. Anaesthetist from Australia

[@nysoravideo]

Thanks for watching!

[@samgoldstein4082]

We would often place 2 ESP catheters on the same side in this case. Connect on On-Q ball x2. Many patients with anticoagulation or antiplatelet requirements, and less risk for hypotension. Yes, analgesia is less dense, but ESP seems to work well at our institution.

[@maritzalastiri5935]

Totally agarre

[@chennakesavulamadhukar4991]

Excellent description thank you very much dearCatherine ma'am and dear Hadzic sir 🙏🙏

[@nysoravideo]

You are most welcome! Keep watching-a lot more videos are coming soon! Greetings from NYSORA!!

[@marcoantoniodiaz6612]

Beautiful technique impeccable

[@nysoravideo]

Thank you! Cheers!

[@chakibbenhamouda161]

Many thanks for sharing this great video.

[@nysoravideo]

Most welcome. Hope it is useful?

[@zakalobi80]

Very useful tips thank you. We usually use 5 ml every 15-20 mins intervals.

[@nysoravideo]

Great 👍

[@setimons]

Hey. Which medication are u using for sedation ?

[@danmark1466]

An aspiration test shoud be perfomed before injecting any fluid into cathether ( NSL or LA) and also performed by empty syringe of two milliliters. Otherwise if the catheter penetrated the Dura Mater no chance to recognize it with your technics. Before era of thoracoscopic approuch we did it a lot and now less common. Depending of patient thoracic epidural placement may be a quite sophistitated procedure, not for beginners. But if you do it well you are a master !

[@nicolascrescimone]

That's why you give a test dose first, immediate pain relieve and hypotension would indicate intrathecal administration. In older people and lateral position, aspiration could be negative even if the catheter is intrathecal.

[@dariansaid3657]

Thank you

[@nysoravideo]

Welcome!

[@rafciosz]

And what do you use for sedation?

[@rishiraj2548]

Thanks

[@nysoravideo]

Most welcome. Hope it was useful?

[@ИльяОсадчий-ж3я]

Thanks for useful video! what thoracic operations are performed in your clinic and what level of anesthesia do you use depending on the operation?

[@nysoravideo]

Thank you for your wonderful comment and support. For more information, I would highly recommend to visit our platform nysoralms.com/courses/regional-anesthesia-manual-e-course/ Greetings from team NYSORA!!

[@nenadkrivokapic7191]

Pa ovo je super

[@maimadkour9946]

How do you determine the level of the puncture ?

[@nysoravideo]

Tip of scapulae = T7. Not absolutely correct, but the epidural injection spreads up/down so not critical. Can use Ultrasound for absolute precision re: level. How do you determine the level?

[@chetanmehra437]

Hello. Aren't we supposed to hit lamina in place of transverse process of spine initially

[@nicolascrescimone]

If she was only one cm lateral of midline, she definitely hit the lamina and not the TP

[@LaitoChen]

Thank you!!!!

[@nysoravideo]

Most welcome. What technique do YOU use?

[@zakalobi80]

Another point: in trauma like this, we make sure that the spine is clear with neurological examination before attempting the thoracic epidural.

[@marianosantopinto]

To be descriptive, the felling is like piercing through a piece of cork. once you feel that, you know you are there!

[@DrSandvik]

In the beginning of the video chest xray showed the heart on right side.

[@maiffa7113]

Hi.. Any recommendations on how to know which level to insert your epidural for an adequate block coverage?

[@cfx3]

It depends on what dermatomes you want covered, but also how far you insert the epidural catheter. In general I would say insert 2-3 levels below the top most dermatome you would want covered by the epidural. Maybe 4 levels if it's a particularly large incision.

[@李闽先]

Why not use ultrasound to determine the spot for puncture in paramedial pathway?

[@李闽先]

Thanks for share😊

[@cfx3]

Somehow despite the paramedian approach for thoracic epidurals being the most logical way, I have a better succesrate in most cases when I do one attempt at median approach, but move on to paramedian approach quickly if I need more than 2-3 needle adjustments. I find that the paramedian approach is more likely to cause patients some discomfort as the trajectory is more innervated and it is not always possible to completely eliminate this with lidocaine infiltration. I also like to check for any previous CT scans of the patient and weigh in the interspinous distance at the different vertebral levels when choosing the trajectory and level.

[@nysoravideo]

Thank you for sharing your experiences! Greetings!

[@lukailic4932]

What level? Which concentration? Which LA? For how long? Tnx

[@TheBravedigger]

T7, 0.1% ropivacaine with sufentanil. It's all in the video...

[@lete2222]

ThanksParamedium👍

[@nysoravideo]

Yes!

[@VITOSAS-u2z]

When I install an epidural, to ensure that the catheter does not displace or come out, I usually tunnel it about 2 cm from the insertion point using the same epidural needle. It has given me good results. There are no problems after its withdrawal. I hope this advice helps you Cuando yo instalo una epidural, para asegurarme que no se desplace o se salga el catéter, suelo tunelizarlo a unos 2 cm del punto de inserción usando la misma aguja epidural. Me ha dado buenos resultados. No hay problemas posteriores a su retiro. Espero les sirva este consejo

[@nysoravideo]

Thank you for sharing your knowledge! Greetings from team NYSORA!

[@briekhnaa]

👍

[@user-gv4fh6xj8w]

Abdomen fluid

[@hanvandendriessche2926]

Thanks

[@nysoravideo]

Welcome