T Grau1, R W Leipold, R Conradi, E Martin. 1. Department of Anaesthesiology, University of Heidelberg, Germany. thomas.grau@med.uni-heidelberg.de
Abstract
BACKGROUND: The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to investigate whether pre-puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia. METHODS: We used digital ultrasound equipment with a 5-MHz transducer to assess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were scheduled for epidural anaesthesia. The women were randomised into two equal groups. In all patients, the standard loss of resistance technique was used. In the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultrasound images was compared to the ES depth measured by the needle. We compared the number of puncture attempts with the standard method (control group) to the number of attempts under ultrasound guidance. RESULTS:Ultrasonography significantly improved operating conditions for epidural anaesthesia. The maximum VAS scores and patient acceptance were significantly better. CONCLUSIONS: With ultrasound measurement of the ES depth, the quality of epidural anaesthesia was enhanced.
RCT Entities:
BACKGROUND: The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to investigate whether pre-puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia. METHODS: We used digital ultrasound equipment with a 5-MHz transducer to assess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were scheduled for epidural anaesthesia. The women were randomised into two equal groups. In all patients, the standard loss of resistance technique was used. In the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultrasound images was compared to the ES depth measured by the needle. We compared the number of puncture attempts with the standard method (control group) to the number of attempts under ultrasound guidance. RESULTS: Ultrasonography significantly improved operating conditions for epidural anaesthesia. The maximum VAS scores and patient acceptance were significantly better. CONCLUSIONS: With ultrasound measurement of the ES depth, the quality of epidural anaesthesia was enhanced.
Authors: Nilam J Soni; Ricardo Franco-Sadud; Ketino Kobaidze; Daniel Schnobrich; Gerard Salame; Joshua Lenchus; Venkat Kalidindi; Michael J Mader; Elizabeth K Haro; Ria Dancel; Joel Cho; Loretta Grikis; Brian P Lucas Journal: J Hosp Med Date: 2019-06-10 Impact factor: 2.960
Authors: Chloe K Nobuhara; W Michael Bullock; Thomas Bunning; Brian Colin; Mary Cooter; Michael J Devinney; Michael N Ferrandino; Jeffrey Gadsden; Grant Garrigues; Ashraf S Habib; Eugene Moretti; Judd Moul; Brian Ohlendorf; Aaron Sandler; Randall Scheri; Bharat Sharma; Jake P Thomas; Christopher Young; Joseph P Mathew; Miles Berger Journal: J Neurol Date: 2020-03-20 Impact factor: 4.849