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The Effects of Shoulder Rotation on the Acoustic Window for Thoracic Paramedian Epidural Approach in the Lateral Decubitus Position

 Byon, Hyo-Jin  ;  Song, Jang-Ho  ;  Song, Kyung-Chul  ;  Lim, Hyunkeun  ;  Kim, Hyunzu 
 Regional Anesthesia and Pain Medicine, Vol.41(5) : 572-575, 2016 
Journal Title
 Regional Anesthesia and Pain Medicine 
Issue Date
Adult ; Analgesia, Epidural/methods* ; Anatomic Landmarks ; Biomechanical Phenomena ; Humans ; Longitudinal Ligaments/anatomy & histology ; Longitudinal Ligaments/diagnostic imaging* ; Male ; Nerve Block/methods* ; Patient Positioning* ; Predictive Value of Tests ; Range of Motion, Articular ; Shoulder/anatomy & histology ; Shoulder/diagnostic imaging* ; Shoulder/physiopathology ; Ultrasonography*
BACKGROUND AND OBJECTIVES: The aim of this study was to examine whether shoulder rotation increases the length of the posterior longitudinal ligament (PLL) in the lateral decubitus position. METHODS: Thirty-four adult male volunteers were placed in the right or left lateral decubitus and flexion position on a horizontal operating table. Thoracic spinal ultrasonography was performed using the paramedian oblique sagittal plane to obtain the optimal ultrasound view for the PLL on the dependent side. The lengths of the PLL were measured at the T6/7 and T9/10 interspaces before and after ipsilateral 30-degree shoulder rotation. RESULTS: In the right lateral decubitus position, the ipsilateral shoulder rotation increased the mean (SD) of the PLL from 7.4 (2.8) to 8.4 (2.6) mm (P = 0.006) at the T6/7 level and from 8.4 (2.9) to 10.6 (2.8) mm (P < 0.0001) at the T9/10 level. Similarly, in the left lateral decubitus position, the ipsilateral shoulder rotation increased the mean (SD) of the PLL from 8.0 (2.6) to 9.1 (2.6) mm (P = 0.001) at the T6/7 level and from 9.3 (2.8) to 11.8 (3.1) mm (P < 0.0001) at the T9/10 level. CONCLUSIONS: Shoulder rotation significantly increased the dimension of the acoustic target window for paramedian thoracic epidural access in the lateral decubitus position at both T6/7 and T9/10 levels. Further clinical studies are needed to investigate the effect of shoulder rotation on thoracic epidural access.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
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