Combined ultrasound and nerve stimulation-guided thoracic epidural catheter placement for analgesia following anterior spine fusion in scoliosis.

Anterior spine fusion by thoracotomy is indicated for the treatment of idiopathic scoliosis. Although epidural (EP) analgesia represents the most effective way to provide adequate analgesia after thoracotomy, scoliosis patients have substantial anatomic variations that make EP catheter placement more difficult and often contraindicated. This case report describes a safe, effective technique for placing a thoracic EP catheter in a young patient undergoing anterior spine fusion surgery by thoracotomy. The procedure was guided by both ultrasound (US) and electrical stimulation of the Tuohy needle and catheter. The combination of US and nerve stimulation in this setting may be associated with easier, potentially safer, and more accurate insertion.