Reply to Dr Yu et al

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To the Editor:
We thank Yu et al1 for their interest in our recent publication on ultrasound-assisted thoracic epidural placement.2 Ultrasound assistance for thoracic epidural needle placement is an emerging field. There are many variations in transducer positions and needle approaches that require further evaluation to show improved placement and efficacy. Dr Yu and colleagues have described a needle placement technique that does vary from our recent publication. With ultrasound, Yu et al identify the junction of the spinous process and lamina in a transverse plane, advancing the Tuohy needle to the junction of these 2 bony landmarks. Then, needle movements replicate a traditional paramedian landmark approach, moving the needle tip cephalad until the interlaminar space is identified. This method could be potentially advantageous by using real-time ultrasound to advance the needle to contact the lamina and also predetermining the necessary medial angulation of the needle for successful epidural placement. However, we encourage Yu et al to continue their exploration of this novel technique through rigorous scientific evaluation, suggesting the use of outcomes that assess epidural placement success or epidural quality. Also, we would like to reiterate that any conclusions drawn from our recent publication pertain only to the ultrasound-assisted thoracic epidural placement technique described in the methodology. We anticipate additional studies on various thoracic epidural placement techniques in the future and are excited to see how these innovations lead to improved patient care.

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