To the Editor
We apologize that the sentence led the readers to misunderstand our original meaning. Splanchnic hypoperfusion happened postoperatively. By administering thoracic epidural analgesia, the occurrence of splanchnic hypoperfusion decreased, and arterial perfusion of the intestinal wall increased.1 Therefore, we mentioned this issue in the sentence, “…sympathetic blockers cause decreased splanchnic hypoperfusion….”
We totally agree with the common notion that “The tip of the epidural catheter should preferably be located at T8–T9.” That was also our preliminary plan for this patient. Besides the reason of celiac ganglia being located in front of the T12 and L1 vertebral bodies, we chose the relatively easily accessible T11–T12 interspinal space in which to insert the needle and indwelled the epidural catheter into the epidural space for 5 cm. However, to our disappointment, the catheter was kinking around the level of T11. We injected 3 mL of contrast medium via the epidural catheter to identify the levels of fluid spread. The epidurogram showed that the contrast medium extended at least upward to T10 and downward to L1 epidural spaces. It was difficult for us to check the upper level above T10 with fluoroscopy owing to the limitation of the base of the surgical table. After the loading dose of 5 mL of 0.2% levobupivacaine, the sensory blockade was, as defined, at around the level of T7–T8. Since this patient was ambulatory, we wanted to prevent hemodynamic instability due to the higher level of thoracic epidural blockade. On account of the reason that the level of sympathetic block might at least be two levels higher than the sensory block,2 we kept the catheter in situ instead of shifting it higher for the injection. The follow-up result came out in favor of our decision.