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A clinical retrospective study comparing thoracic epidural catheterization between awake and anesthetized patients
Anesth Pain Med 2019;14(1):95-101
Published online January 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Seok-Jin Lee , Sung-Ae Cho , Chi Bum In , Tae-Yun Sung , and Po-Soon Kang
Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
Correspondence to: Corresponding author Tae-Yun Sung, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea Tel: 82-42-600-9316 Fax: 82-42-600-9398 E-mail:
Received May 31, 2018; Revised August 23, 2018; Accepted September 1, 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.


The clinical outcomes and safety of thoracic epidural catheterization in anesthetized adult patients has not yet been established. The purpose of this study was to compare clinical differences between epidural catheterization performed before and after anesthesia for postoperative pain control.


The medical records of 549 patients who received thoracic epidural catheterization before (awake group, n = 303) or after (anesthetized group, n = 246) induction of anesthesia for major abdominal surgery were reviewed retrospectively.


The catheter insertion time (1.6 ± 1.5 vs. 1.1 ± 1.2 min; 95% confidence interval [95% CI], 0.3–0.8; effect size, 0.368; P < 0.001) and number of attempts required for successful epidural catheterization (1 [1, 3] vs. 1 [1, 2], P = 0.003) were increased in the awake group. The incidence rates of dural puncture, vascular injury and postoperative paresthesia were similar between the two groups. The median surgical site numerical rating scale pain score (0 = no pain, 10 = worst pain imaginable) was lower in the awake group than in the anesthetized group (3 vs. 4 on postoperative day 1, P < 0.001; and 2 vs. 3 on postoperative day 3, P = 0.002). Serious complications, including meningitis, epidural abscess, epidural hematoma, spinal cord injury, and paraplegia, were not observed in either group.


Successful epidural catheterization before induction of anesthesia required more attempts versus after anesthesia. Overall complication rates of thoracic epidural catheterization were similar regardless of the timing of the procedure.

Key Words : Catheterization, Epidural analgesia, Postoperative complications

July 2019, 14 (3)
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