Selective epidurography for the assessment of epidural catheter placement after esophagectomy.

Abstract

BACKGROUND\nAdequate pain control immediately after esophagostomy is critical to patient recovery and may be compromised by uncertainty regarding correct epidural catheter placement. The aim of the current study was to determine the role of performing an epidurogram in selective patients to assess epidural placement after esophagectomy.\n\n\nMETHODS\nPatients undergoing esophagectomy in a high-volume center were retrospectively reviewed to identify those in whom an epidurogram was performed <24hrs after surgery. Since 2012, epidurograms have been selectively performed in patients demonstrating features concerning for incorrect epidural catheter placement, including: difficult/complicated insertion; negative sensory test; non-reassuring intraoperative haemodyamic response, and; inadequate postoperative pain control..\n\n\nRESULTS\nFifty-two (27%: 43 Male; 65±11yrs) of 192 patients who underwent esophagostomy since 2012 had an epidurogram. Epidurograms were not associated with any adverse events. In 21 (40%) patients epidurogram findings led to a direct change in patient management, prompting either: removal/replacement of an incorrectly sited catheter (n=9); partial withdrawal of a catheter associated with unilateral contrast distribution (n=2), or; by endorsing a clinical decision to modify analgesic regimen in a patient with a correctly sited epidural catheter (n=10). Identifying and rescuing incorrect epidural catheter placement was not associated with longer ICU/hospital stay or postoperative morbidity (P>0.05) CONCLUSIONS: This is the first study to review selective epidurogram use in esophagectomy patients to determine its role in rescuing inadequate pain control through expediting clinical decision-making. Findings confirm that in selected patients epidurography can is feasible and has the potential to directly contribute to patient care.