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ObjectivesThis study aimed to examine the incidence of epidural catheter tip malposition using postoperative CT images, and investigated its relationship with anesthesiologist and patient characteristics.MethodsPatients who had undergone epidural anesthesia at our hospital during the previous 18 years, and who had a thorax and abdominal CT scan within 5 days after surgery were included. Malposition was defined if the tip of the catheter did not penetrate the ligamentum flavum in postoperative CT images.ResultsAmong 189 eligible patients (median age 71 years, range 15–89), 78 (41%) were female. The median number of years of postgraduate experience of the physicians inserting the epidural catheter was 5.7 years (range 2.0–35.4). All epidural catheters were inserted using the paramedian approach in the left lateral decubitus position. The puncture site was the middle (48%) or lower (49%) thoracic spine. Epidural catheter malposition was observed in 24 patients (12.7%, 95% confidence interval [CI] 8.3–18.3). Among these cases, catheter tips were located at the vertebrae (vertebral arches: 9, transverse processes: 2, spinous process: 1), in superficial soft tissue (erector spinae: 5, subcutaneous: 4), and in deep soft tissue (intervertebral foramina: 2, subpleural space: 1). Anesthesiologists in the malposition group had significantly more experience since graduation (median 10.1 years vs. 5.6 years, P = 0.010). No other characteristics showed an association with catheter malposition.ConclusionsAnalysis of postoperative CT images revealed that the epidural catheter tip did not penetrate the ligamentum flavum in approximately 13% of cases. Our results suggest that even experienced anesthesiologists should be vigilant regarding proper catheter tip positioning.研究目的：本研究旨在借助术后CT影像，探究硬膜外导管（epidural catheter）尖端异位的发生率，并分析其与麻醉医师及患者特征的关联。 研究方法：纳入本院近18年间接受硬膜外麻醉，且于术后5天内完成胸腹部CT扫描的患者。本研究将术后CT影像中导管尖端未穿透黄韧带（ligamentum flavum）的情况定义为导管异位。 研究结果：共纳入189例符合标准的患者（年龄中位数71岁，范围15~89岁），其中女性78例（占比41%）。置入硬膜外导管的医师毕业后从业年限中位数为5.7年（范围2.0~35.4年）。所有硬膜外导管均于左侧卧位下采用旁正中入路置入，穿刺位点为胸椎中段（48%）或下段（49%）。共24例患者出现硬膜外导管尖端异位（占比12.7%，95%置信区间[CI] 8.3~18.3）。异位病例中，导管尖端分别位于椎骨（椎弓9处、横突2处、棘突1处）、浅表软组织（竖脊肌5处、皮下组织4处）及深部软组织（椎间孔2处、胸膜下间隙1处）。异位组麻醉医师的毕业后从业年限显著更长（中位数10.1年 vs. 5.6年，P=0.010），其余特征均与导管异位无显著关联。 研究结论：术后CT影像分析显示，约13%的病例中硬膜外导管尖端未穿透黄韧带。本研究结果提示，即便经验丰富的麻醉医师也应警惕导管尖端的正确定位问题。