Real-time ultrasound-guided thoracic epidural catheter placement in a patient with severe scoliosis: A case report

Thoracic epidural analgesia is the established favored modality for procedural multimodal analgesia for thoracotomy and major abdominal surgery. Ultrasound assistance and real time guidance in the insertion of thoracic epidurals has been demonstrated. However, the studies specifically excluded patients with spinal deformities. We present a case of an elderly patient with severe scoliosis, in whom real time ultrasound guided thoracic epidural catheter placement was employed with success on one needle pass. Ultrasound and imaging guidance can be used in those with spinal deformity to assist in successful thoracic epidural placement.