0:09 - Morphology of the thoracic spine 0:40 - Lumbar vs thoracic vertebra 1:11 - Transverse view on US 2:08 - Parasagittal oblique view on US 3:01 - How US imaging helps in epidural insertion 4:23 - Examples of difficult thoracic interspaces 5:01 - Importance of the lateral-to-medial angle 6:02 - Caudal-to-cranial needle trajectory 6:48 - Estimating needle insertion depth 8:05 - Video of thoracic epidural insertion 9:53 - Identifying intervertebral levels with US 10:31 - How to count down from the first rib

@oshabana

2 жыл бұрын

Thanks alot for the great video! After hitting the lamina at thoracic epidurals How much should i withdraw the needle before directing it more cephalic? Just a few mm,s or withdraw it till just before the skin?

@KiJinnChin

2 жыл бұрын

@@oshabana you should withdraw as much as is necessary to be able to change your angle WITHOUT exerting force that will bend your needle. Never bend any needle. You will probably find that you can make small angles of change without withdrawing too far; for larger angles of change, you will have to withdraw out of the muscle and make a new insertion track.

@oshabana

2 жыл бұрын

@@KiJinnChin thx alot sir!

@MISSLOVELY_REE

Жыл бұрын

I need a shot in my back thoracic muscle its moving 🤷🏾‍♂️😔

Everything in this video is really helpful. Thank you.

Thank you Dr. Chinn!

Very good video, thank you!

Great video thank you so much

Great video, thanks! Do you ever do these with real-time ultrasound?

@KiJinnChin

4 жыл бұрын

No, not personally. I find it too complex for a single operator. But this is the best description I have seen of it - www.ncbi.nlm.nih.gov/pubmed/29553999 and could be worth trying.

Thank you so much.

Is it midline approach?

@KiJinnChin

2 жыл бұрын

Not quite - strictly it is a paramedian approach - entry through the paramedian interlaminar window. But because we are so close to the spinous process, this is very similar to the trajectory that would result if you used the "midline" landmarkguided approach. The needle in the midline LMG approach usually passes just alongside the spinous processes, not strictly between them as they are so narrow.