Accuracy of the Thoracic Epidural Catheter Insertion Confirmed by Fluoroscopic Imaging

• Presumed intervertebral level of epidural catheter [ Time Frame: During procedure ] [ Designated as safety issue: No ]
  At the time of thoracic epidural catheter insertion
  
  

• Radiologic confirmation of epidural catheter placement [ Time Frame: Post procedure within one week. ] [ Designated as safety issue: No ]
  Radiology department will assess within one week after the procedure the images, to confirm the epidural catheter placement.
  
  
• Change in Numeric Rating Pain Score from baseline [ Time Frame: 1, 24 and 48 hrs ] [ Designated as safety issue: No ]
  1, 24, and 48 hrs after the end of the surgery.
  
  

• Patient satisfaction [ Time Frame: Post procedure at 48 hours ] [ Designated as safety issue: No ]
  Patient satisfaction 48 hrs after the end of surgery
  
  

Thoracic epidural analgesia (TEA) is a key tool in management of pain after thoracic or upper abdominal surgery. TEA optimizes pain relief while minimizing the use of systemic opioids, thus reducing the duration of postoperative ileus. TEA also attenuates surgical stress response and allows for early mobilization. Despite all the touted benefits of TEA, much controversy limits its use for post surgical pain due to fear of exceedingly rare, if not entirely theoretical complication of epidural hematoma.

Beneficial effects of TEA require that catheter placement and infusate be targeted at the thoracic segments innervating injured skin, muscle, and bone from which pain input originates. The purpose of this study is to determine the accuracy of thoracic epidural continuous catheter insertion by using fluoroscopic imaging.