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Appropriate angle and depth in thoracic transforaminal epidural block in Koreans
Anesth Pain Med 2018;13(4):427-34
Published online October 31, 2018
© 2018 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Chan Noh, Won Hyung Lee , Young Kwon Ko, Sun Yeul Lee, Yeo Jung Kim, Seoung Hun Lee, Choon Ho Jung, and Hye Min Kang
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
Correspondence to: Won Hyung Lee, M.D., Ph.D.
Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea
Tel: 82-42-280-7840
Fax: 82-42-280-7968
Received January 26, 2018; Revised June 23, 2018; Accepted June 25, 2018.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Selective transforaminal epidural block has come to the for as a target-specific modality in the treatment and diagnosis of spinal pain. Thoracic transforaminal epidural block (TTFEB) has the associated risk of pneumothorax. This article describes a retrospective study conducted using computed tomography (CT) imaging to investigate the TTFEB angle and depth appropriate to minimize the risk of pneumothorax in Koreans.
Methods: The subjects of the present study were 100 randomly selected patients between 50 and 70 years of age found be free of thoracic disease according to chest CT performed in the present hospital. On the chest CT, the superior, middle, and inferior thoracic vertebrae were observed at the T2, T7, and T11 levels, respectively.
Results: The average distance and the needle insertion angle from the skin point at which the needle may be inserted without piercing the lung to the intervertebral foramen were 117.8 ± 12.1 mm and 58.1 ± 6.1° at the T2 level, 85.6 ± 10.0 mm and 61.7 ± 4.3° at the T7 level, and 94.3 ± 8.7 mm and 64.4 ± 7.0° at the T11 level, respectively.
Conclusions: The needle insertion at the point further than 40 mm, on the upper, middle thorax, if the needle pass from the inner vertebral body to lamina, it could be safer. However, on the lower thorax, needle could pierce the lung though the needle start from the inner vertebral body. Thus, it can be safer if the needle pass toward the exterior margin of lamina.
Key Words : Angle; Depth; Pneumothorax; Thoracic transforaminal epidural block.

October 2018, 13 (4)
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