Matsuo Mitsuhiro, Sakamoto Natsumi, Takebe Mariko, Takazawa Tomonori
Department of Anesthesiology, University of Toyama, Toyama, Japan.
PLoS One. 2025 Jun 26;20(6):e0316304. doi: 10.1371/journal.pone.0316304. eCollection 2025.
This study aimed to examine the incidence of epidural catheter tip malposition using postoperative CT images, and investigated its relationship with anesthesiologist and patient characteristics.
Patients who had undergone epidural anesthesia at our hospital during the previous 18 years, and who had a thorax and abdominal CT scan within 5 days after surgery were included. Malposition was defined if the tip of the catheter did not penetrate the ligamentum flavum in postoperative CT images.
Among 189 eligible patients (median age 71 years, range 15-89), 78 (41%) were female. The median number of years of postgraduate experience of the physicians inserting the epidural catheter was 5.7 years (range 2.0-35.4). All epidural catheters were inserted using the paramedian approach in the left lateral decubitus position. The puncture site was the middle (48%) or lower (49%) thoracic spine. Epidural catheter malposition was observed in 24 patients (12.7%, 95% confidence interval [CI] 8.3-18.3). Among these cases, catheter tips were located at the vertebrae (vertebral arches: 9, transverse processes: 2, spinous process: 1), in superficial soft tissue (erector spinae: 5, subcutaneous: 4), and in deep soft tissue (intervertebral foramina: 2, subpleural space: 1). Anesthesiologists in the malposition group had significantly more experience since graduation (median 10.1 years vs. 5.6 years, P = 0.010). No other characteristics showed an association with catheter malposition.
Analysis of postoperative CT images revealed that the epidural catheter tip did not penetrate the ligamentum flavum in approximately 13% of cases. Our results suggest that even experienced anesthesiologists should be vigilant regarding proper catheter tip positioning.
本研究旨在利用术后CT图像检查硬膜外导管尖端位置不当的发生率，并探讨其与麻醉医生及患者特征的关系。
纳入我院此前18年间接受硬膜外麻醉且术后5天内进行胸部和腹部CT扫描的患者。若术后CT图像显示导管尖端未穿透黄韧带，则定义为位置不当。
189例符合条件的患者（中位年龄71岁，范围15 - 89岁）中，78例（41%）为女性。插入硬膜外导管的医生的研究生毕业后中位工作年限为5.7年（范围2.0 - 35.4年）。所有硬膜外导管均采用左侧卧位旁正中入路插入。穿刺部位为胸椎中部（48%）或下部（49%）。观察到24例患者（12.7%，95%置信区间[CI] 8.3 - 18.3）硬膜外导管位置不当。在这些病例中，导管尖端位于椎体（椎弓：9例，横突：2例，棘突：1例）、浅表软组织（竖脊肌：5例，皮下：4例）和深部软组织（椎间孔：2例，胸膜下间隙：1例）。位置不当组的麻醉医生毕业后的经验显著更丰富（中位10.1年 vs. 5.6年，P = 0.010）。没有其他特征显示与导管位置不当有关。
术后CT图像分析显示，约13%的病例中硬膜外导管尖端未穿透黄韧带。我们的结果表明，即使是经验丰富的麻醉医生也应警惕导管尖端的正确定位。
