Assessing the Depth of the Subarachnoid Space by Ultrasound

Gnaho, Alexandre; Nguyen, Vina P.; Villevielle, Thierry; Frota, Melina; Marret, Emmanuel; Gentili, Marc Emmanuel

doi:10.1016/s0034-7094(12)70150-2

Cited by 31 publications

(26 citation statements)

References 21 publications

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“…[27][28][29]34 Since a previous review, 43 more data have become available for non-obstetric patients 22,25,26,33,37,[39][40][41] and for patients presumed at risk for difficult insertion due to obesity, scoliosis, or previous surgery. 33 These special patient populations are clinically important because they are at increased risk for technical difficulty.…”

Section: Discussionmentioning

confidence: 99%

“…The Pearson correlation coefficient reported by the individual studies ranged from 0.66 to 0.98. 23,26,30 The pooled Pearson product moment correlation coefficient was 0.91 (95% CI, 0.87-0.94), using a randomeffects model to account for heterogeneity, suggesting the ultrasound-measured depth of the epidural space was highly correlated with the depth of the epidural space measured during the epidural needle insertion (Fig. 2).…”

Section: Does Neuraxial Ultrasound Accurately Predict the Needle Insementioning

confidence: 98%

“…[20][21][22][23][24][25][26][27][28][29][30][31][32] Nine studies were performed in obstetric patients, 20,21,23,24,[27][28][29]31,32 3 in non-obstetric surgical patients (urology, vascular, and orthopedics), 22,26,30 and 1 in patients requiring a diagnostic lumbar puncture in the emergency department. 25 The quality of the studies was generally good, with the most common deficiency being unclear patient selection criteria.…”

Section: Does Neuraxial Ultrasound Accurately Predict the Needle Insementioning

confidence: 99%

“…Fourteen RCTs involving 1768 patients [27][28][29][32][33][34][35][36][37][38][39][40][41][42] (Table 4) and 5 prospective cohort studies involving 227 patients [20][21][22]25,26 examined efficacy and safety outcomes. Eight RCTs [27][28][29]32,34,36,38,42 and 2 cohort studies 20,21 evaluated epidural analgesia in obstetric patients, whereas 3 RCTs 33,37,39 and 2 cohort studies 22,26 evaluated spinal anesthesia in orthopedic procedures.…”

Section: Does Neuraxial Ultrasound Improve the Efficacy Or Safety Of mentioning

confidence: 99%

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Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

Perlas

Chaparro

Chin

2016

Regional Anesthesia and Pain Medicine

278

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We know that neuraxial ultrasound is a useful complement to clinical examination when performing lumbar central neuraxial blocks. It provides anatomical information including the depth of the epidural space, the identity of a given intervertebral level, and the location of the midline and interspinous/interlaminar spaces. This information can be used to successfully guide subsequent needle insertion.Since 2010, new data from RCTs and 1 meta-analysis suggest that neuraxial ultrasound increases the success and reduces the technical difficulty of lumbar central neuraxial blocks. Findings from the meta-analysis suggest that neuraxial ultrasound reduces the risk of traumatic procedures, and thus may possibly contribute to the safety of lumbar central neuraxial blocks.

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Section: Discussionmentioning

confidence: 99%

Section: Does Neuraxial Ultrasound Accurately Predict the Needle Insementioning

confidence: 98%

Section: Does Neuraxial Ultrasound Accurately Predict the Needle Insementioning

confidence: 99%

Section: Does Neuraxial Ultrasound Improve the Efficacy Or Safety Of mentioning

confidence: 99%

See 2 more Smart Citations

Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

Perlas

Chaparro

Chin

2016

Regional Anesthesia and Pain Medicine

278

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“…18 Depth of the ligamentum flavum can be accurately measured from either a longitudinal paramedian or transverse midline view, although identification and measurement of the ligamentum flavum may be easier from a longitudinal paramedian view. 6,19,20 Most important, ultrasound allows the provider to select the widest interspinous space with the highest likelihood of a successful procedure.…”

Section: Literature Reviewmentioning

confidence: 99%

Ultrasound guidance for lumbar puncture

et al. 2016

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Purpose of review: To review the literature and describe techniques to use ultrasound to guide performance of lumbar puncture (LP). Recent findings:Ultrasound evaluation of the lumbar spine has been shown in randomized trials to improve LP success rates while reducing the number of attempts and the number of traumatic taps. Summary: Ultrasound mapping of the lumbar spine reveals anatomical information that is not obtainable by physical examination, including depth of the ligamentum flavum, width of the interspinous spaces, and spinal bone abnormalities, including scoliosis. Using static ultrasound, the lumbar spine anatomy is visualized in transverse and longitudinal planes and the needle insertion site is marked. Using real-time ultrasound guidance, the needle tip is tracked in a paramedian plane as it traverses toward the ligamentum flavum. Future research should focus on efficient methods to train providers, costeffectiveness of ultrasound-guided LP, and the role of new needle-tracking technologies to facilitate the procedure. Neurol Clin Pract 2016;6:358-368 P oint-of-care ultrasound is being increasingly used to guide bedside procedures. For certain bedside procedures, such as central venous catheterization, use of ultrasound guidance is now considered the standard of care. For other procedures, such as lumbar puncture (LP), ultrasound can facilitate performance of the procedure by revealing underlying anatomy. Although many clinicians can perform LP based on landmarks with high success rates, an increasing body of evidence supports the use of ultrasound guidance, particularly in obese patients with less palpable landmarks. A recent study demonstrated a 19% failure rate of LPs performed in a neurology clinic when landmarks alone were used. A strong correlation between body mass index (BMI) and procedure failure was shown with half of the failed LPs in patients with a BMI .35.

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