OP048 Conventional anatomical landmark versus preprocedural ultrasound for thoracic epidural analgesia: A systematic review and meta-analysis

• Published in: Regional anesthesia and pain medicine Vol. 48; no. Suppl 1; p. A29
• Main Authors: Sharapi, Mahfouz, Mektebi, Ammar, Philip, Kerollos George, Albakri, Khaled Anwer, Mahfouz, Amany E
• Format: Journal Article
• Language: English
• Published: Secaucus BMJ Publishing Group Ltd 01-09-2023; BMJ Publishing Group LTD
• Subjects: Epidural; Epidural needle redirection; First-puncture success rate; landmark-based thoracic epidural; Preprocedural thoracic ultrasound; Success; Systematic review; Thoracic epidural placement (TEP); Ultrasonic imaging; Ultrasound guided RA (UGRA) – Free papers 5
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1136/rapm-2023-ESRA.48

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page) Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)Background and AimsThoracic epidural analgesia is the gold standard for major thoracic and upper abdominal surgeries. To effectively perform epidural analgesia, the epidural space should be localised accurately. Various techniques have been described the facilitate accurate needle insertion; including surface landmark and ultrasound-assisted techniques. Practitioners have relied on the surface palpation landmark method and loss extensively. However, this technique can sometimes be challenging to access the thoracic epidural area and carries substantial failure rates, especially in obese patients or those with oedema on the back This meta-analysis compares the efficacy of the US-assisted versus landmark-based thoracic epidural insertion via the paramedian route.MethodsRandomized controlled trials were sought in six databases for a systematic review and meta-analysis. With a 95% confidence interval, a fixed-effects model calculated Risk Ratio or Mean Difference. Cochrane Risk of Bias assessed bias. Four RCTs were examined. The study was registered with PROSPERO with the identifying code CRD42022360527.ResultsPreprocedural ultrasound increased thoracic epidural placement first puncture success rate (RR= 1.28, 95% CI [1.05 to 1.56], P value= 0.02) and decreased the need for two or more skin punctures (MD= -2.41, 95% CI [-3.34 to -1.47], P value= 0.00001). The ultrasound group reduced needle redirections (RR= 0.6, 95% CI [0.38 to 0.94], P value= 0.02). The epidural block success rate was equal in both groups (RR= 1.02, 95% CI [0.96 to 1.07], P value= 0.6).Abstract OP048 Figure 1Forest plot of the first rate success rate of thoracic epidural placementAbstract OP048 Figure 2Forest plot of the number of needle redirectionsAbstract OP048 Figure 3Forest plot of the rate of successful epidural blockConclusionsThoracic epidural insertion is improved by ultrasound but not the success rate. Quality research with larger samples is needed to emphasise that.