Loss of Resistance With Nerve Stimulation Versus Loss of Resistance Alone; Effect on Success of Thoracic Epidural Placement.
Overview
- Phase
- Phase 4
- Intervention
- Thoracic epidural block
- Conditions
- Anesthesia
- Sponsor
- Wake Forest University Health Sciences
- Enrollment
- 100
- Locations
- 1
- Primary Endpoint
- Success Rate of Placement of a Thoracic Epidural
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
The purpose of this randomized, observer-blinded, investigative trial is to determine if the use of electrical stimulation, compared to the traditional loss of resistance technique alone, improves the success rate of epidural catheter placement at an academic teaching institution.
Detailed Description
All subjects will receive a thoracic epidural catheter placement at the level appropriate for their surgery and will be randomized to either have the epidural placed with a loss of resistance technique alone or loss of resistance technique with confirmation by nerve stimulation. In the traditional loss of resistance technique group, the epidural catheter will be placed after achieving loss of resistance to air. In the electrical stimulation group, following the location of the epidural space with a loss of resistance technique (using air), nerve stimulation will be utilized to elicit a myotomal contraction of the abdominal or thoracic wall. Nerve stimulation will be started at a pulse width of 0.3 ms and a frequency of 1 Hz and a current of 0.2mA.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Adults undergoing intra-thoracic or intra-abdominal procedures that normally would receive thoracic epidurals for post-operative analgesia will be eligible.
Exclusion Criteria
- •Subjects with contraindications to regional anesthesia:
- •history of allergy to amide local anesthetics
- •presence of a progressive neurological deficit
- •patients that are on anticoagulant medications that prohibit placement of an epidural
- •Systemic infection
- •Infection at the site of placement
Arms & Interventions
Traditional Technique Group
In the traditional loss of resistance technique group, the epidural catheter will be placed after achieving loss of resistance to air. After placement of the catheter a standard test dose of 3+2 ml of 1.5% lidocaine with 1:200,000 epinephrine will be administered.Solution for Thoracic epidural block.
Intervention: Thoracic epidural block
Traditional Technique Group
In the traditional loss of resistance technique group, the epidural catheter will be placed after achieving loss of resistance to air. After placement of the catheter a standard test dose of 3+2 ml of 1.5% lidocaine with 1:200,000 epinephrine will be administered.Solution for Thoracic epidural block.
Intervention: Solution For Thoracic epidural block
Electric Stimulation Group
In the electrical stimulation group, following the location of the epidural space with a loss of resistance technique (using air), nerve stimulation will be utilized to elicit a myotomal contraction of the abdominal or thoracic wall. After placement of the catheter a standard test dose of 3+2 ml of 1.5% lidocaine with 1:200,000 epinephrine will be administered.Solution for Thoracic epidural block.Thoracic epidural block with Electrical Nerve stimulation
Intervention: Thoracic epidural block
Electric Stimulation Group
In the electrical stimulation group, following the location of the epidural space with a loss of resistance technique (using air), nerve stimulation will be utilized to elicit a myotomal contraction of the abdominal or thoracic wall. After placement of the catheter a standard test dose of 3+2 ml of 1.5% lidocaine with 1:200,000 epinephrine will be administered.Solution for Thoracic epidural block.Thoracic epidural block with Electrical Nerve stimulation
Intervention: Electrical Nerve stimulation
Electric Stimulation Group
In the electrical stimulation group, following the location of the epidural space with a loss of resistance technique (using air), nerve stimulation will be utilized to elicit a myotomal contraction of the abdominal or thoracic wall. After placement of the catheter a standard test dose of 3+2 ml of 1.5% lidocaine with 1:200,000 epinephrine will be administered.Solution for Thoracic epidural block.Thoracic epidural block with Electrical Nerve stimulation
Intervention: Solution For Thoracic epidural block
Outcomes
Primary Outcomes
Success Rate of Placement of a Thoracic Epidural
Time Frame: 15 minutes after administration of a test dose of lidocaine
will be determined by the detection of a loss of sensation to cold (ice) in at least two contiguous dermatomal levels, 15 minutes after administration of a test dose of lidocaine through the epidural catheter. If a loss of cold sensation is found, then the epidural placement will be classified as successful. If no loss of cold sensation is found, then the epidural placement will be classified as unsuccessful.
Secondary Outcomes
- Time Required to Place the Epidural Catheter(From the initiation of procedure to end of procedure)
- Number of Thoracic Spine Levels Attempted(Thirty minutes after start of procedure.)