Which is a better position for insertion of a high thoracic epidural catheter: sitting or lateral decubitus?

OBJECTIVE

The purpose of this study was to compare the safety and success rates associated with the placement of a high thoracic epidural catheter in the sitting vs. the lateral decubitus position.

DESIGN

Prospective randomized study.

SETTING

University hospital.

PARTICIPANTS

Forty-one patients scheduled for off-pump coronary artery bypass graft surgery (OPCAB) by means of high thoracic epidural anesthesia at Th 1/2.

INTERVENTIONS

The epidural catheter was placed into the patients in the sitting or lateral decubitus position. The success rates, the time for catheter insertion, the incidence of adverse events, and the accuracy of the catheterization in both groups were compared.

MEASUREMENTS AND MAIN RESULTS

The success rates in both groups were comparable, whereas 20% of patients showed a vagal reflex during epidural catheterization in the sitting group (p < 0.05). The insertion time in the sitting group was significantly shorter than in the lateral decubitus group (p < 0.05). Accuracy at the first attempt to the Th1/2 epidural space was 93% in the sitting group and 73% in the lateral decubitus group, but there was no statistically significant difference (p = 0.186).

CONCLUSIONS

It is recommended to use the lateral decubitus position for high thoracic epidural catheterization in patients scheduled for OPCAB to avoid vagal reflexes.