Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents

Alagoz, Ali; Sazak, Hilal; Tunc, Mehtap; Ulus, Fatma; Kokulu, Serdar; Pehlivanoglu, Polat; Sahin, Saziye

doi:10.1016/j.bjane.2014.07.010

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Scientific Articles • Rev. Bras. Anestesiol. 66 (1) • Jan-Feb 2016 • https://doi.org/10.1016/j.bjane.2014.07.010 copy

Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents^☆ ☆ This study was presented as a poster World Institute of Pain 6th World Congress of World Institute of Pain. February 4-6, 2012, Miami Beach, Florida, US.

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES:

In this study, we aimed to clarify the importance of residency grade and other factors which influence the success of thoracic epidural catheterization in thoracotomy patients.

METHODS:

After the ethical committee approval, data were recorded retrospectively from the charts of 415 patients. All patients had given written informed consent. The thoracic epidural catheterization attempts were divided into two groups as second-third year (Group I) and fourth year (Group II) according to residency grade. We retrospectively collected demographic data, characteristics of thoracic epidural catheterization attempts, and all difficulties and complications during thoracic epidural catheterization.

RESULTS:

Overall success rate of thoracic epidural catheterization was similar between the groups. Levels of catheter placement, number and duration of thoracic epidural catheterization attempts were not different between the groups (p > 0.05). Change of needle insertion level was statistically higher in Group II (p = 0.008), whereas paresthesia was significantly higher in Group I (p = 0.007). Dural puncture and postdural puncture headache rates were higher in Group I. Higher body mass index and level of the insertion site were significant factors for thoracic epidural catheterization failure and postoperative complication rate and those were independence from residents' experience (p < 0.001, 0.005).

CONCLUSION:

Body mass index and level of insertion site were significant on thoracic epidural catheterization failure and postoperative complication rate. We think that residents' grade is not a significant factor in terms overall success rate of thoracic epidural catheterization, but it is important for outcome of these procedures.

Residency training; Thoracic epidural catheterization; Failure rate; Complications

Variables	Group 1 (n = 203) (mean ± SD)	Group 2 (n = 212) (mean ± SD)	p
Age (year)	49.2 ± 15.7	52.6 ± 14.5	0.020^a

Gender			0.436
Male	157 (77.3%)	157 (74.1%)
Female	46 (22.7%)	55 (25.9%)

BMI (kg/m ² )	25.4 ± 4.0	25.3 ± 4.3	0.899

Distribution by BMI (kg/m ² )			0.546
18.5	7 (3.4%)	7 (3.3%)
18.5–25	92 (45.3%)	103 (48.6%)
25–30	76 (37.4%)	66 (31.1%)
>30 kg	28 (13.8%)	36 (17.0%)

ASA			0.560
I	3 (1.5%)	1 (0.5%)
II	106 (52.2%)	113 (53.3%)
III	94 (46.3%)	98 (46.2%)

Variables	Group I (n = 203)	Group II (n = 212)	p
Touhy needle insertion level			0.257
Thoracic 4–5	55 (27.1%)	53 (25.0%)
Thoracic 5–6	50 (24.6%)	42 (19.8%)
Thoracic 6–7	42 (20.7%)	61 (28.8%)
Thoracic 7–8	56 (27.6%)	56 (26.4%)

Number of attempts			0.320
1	93 (45.8%)	91 (42.9%)
2	48 (23.6%)	42 (19.8%)
3	62 (30.5%)	79 (37.3%)

^a Duration of TEC attempts (min)			0.715
0–5	101 (49.8%)	99 (46.7%)
5–10	66 (32.5%)	77 (36.3%)
10–15	36 (17.7%)	36 (17.0%)

Variables	Group I (n = 203)	Group II (n = 212)	p
Number of insertion level change	46 (23.0%)	72 (35.0%)	0.008^a
Bleeding^b	16 (8.0%)	15 (7.3%)	0.785
Dural puncture	3 (1.5%)	1 (0.5%)	0.366
Difficulty of catheter advance	4 (2.0%)	7 (3.4%)	0.386
Paresthesia	7 (3.5%)	–	0.007^a
Complications during TEC	25 (12.5%)	20 (9.7%)	0.370
TEC failure rate	18 (8.9%)	19 (9.0%)	0.973
Patients’ satisfaction			0.857
Excellent	103 (50.7%)	102 (48.1%)
Good	61 (30.0%)	66 (31.1%)
Moderate	36 (17.8%)	42 (19.8%)
Bad	3 (0.15%)	2 (0.1%)

	Complications during TEC		Procedure failure		Postoperative Complications
	OR (95% CI)	p	OR (95% CI)	p	OR (95% CI)	p
Experience
4th year	1.000	–	1.000	–	1.000	–
2nd–3rd year	1.329 (0.712–2.478)	0.953	1.022 (0.499–2.095)	0.953	0.947 (0.464–1.933)	0.882

BMI (kg/m²)
<18.5	1.000		1.000		1.000
18.5–25	1.630 (0.338–7.861)	0.543	1.535 (0.172–13.718)	0.701	0.857 (0.100–7.318)	0.888
25–30	1.770 (0.904–3.465)	0.096	2.985 (1.172–7.150)	0.021^a	0.905 (0.373–2.194)	0.825
>30	0.686 (0.223–2.111)	0.511	5.673 (2.186–14.728)	<0.001^a	3.196 (1.372–7.447)	0.007^a

Insertion level
T7–8	1.000		1.000		1.000
T4–5	2.099 (0.891–4.943)	0.090	2.025 (0.559–7.334)	0.282	0.660 (0.209–2.088)	0.480
T5–6	1.528 (0.604–3.867)	0.371	3.420 (1.008–11.601)	0.049^a	2.904 (1.190–7.088)	0.019^a
T6–7	0.977 (0.362–2.639)	0.963	5.204 (1.647–16.449)	0.005^a	0.704 (0.237–2.094)	0.528

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:mdalagoz@gmail.com (A. Alagoz).

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Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents☆ ☆ This study was presented as a poster World Institute of Pain 6th World Congress of World Institute of Pain. February 4-6, 2012, Miami Beach, Florida, US.

BACKGROUND AND OBJECTIVES:

METHODS:

RESULTS:

CONCLUSION:

Teaching practices of thoracic epidural catheterizations in different grade of anesthesia residents^☆ ☆ This study was presented as a poster World Institute of Pain 6th World Congress of World Institute of Pain. February 4-6, 2012, Miami Beach, Florida, US.