Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia

Schlotterbeck, Hervé; Schaeffer, Richard C.; Dow, W. Allister; Touret, Yasmina; Bailey, Steven H.; Diemunsch, Pierre

doi:10.1093/bja/aem371

Cited by 98 publications

(64 citation statements)

References 16 publications

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“…It has been shown repeatedly that clinical estimation of the lumbar intervertebral level using surface landmarks, such as the intercristal line, is inaccurate. [15][16][17][18][19][20][21] Our results are consistent with previous studies in that, when an error does occur, the actual intervertebral level tends to be higher than presumed, rather than lower. [16][17][18][19][20][21] It should be noted, however, that ultrasonographic determination of intervertebral level has not been fully validated against more definitive imaging methods.…”

Section: Discussionsupporting

confidence: 90%

“…[15][16][17][18][19][20][21] Our results are consistent with previous studies in that, when an error does occur, the actual intervertebral level tends to be higher than presumed, rather than lower. [16][17][18][19][20][21] It should be noted, however, that ultrasonographic determination of intervertebral level has not been fully validated against more definitive imaging methods. 19,22 Second, the LP scan generally affords better visibility of the LF/D and the PVB than the TM scan, an observation that was also made by Grau et al 23 The interspinous space is narrowed by the anatomic changes of aging (loss of vertebral height, osteophyte formation, and decreased ability to flex the lumbar spine), 3 and this can make it challenging to visualize the LF/D or the PVB on the TM scan.…”

Section: Discussionsupporting

confidence: 90%

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An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty

Chin

Perlas

Singh

et al. 2009

Can J Anesth/J Can Anesth

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Purpose Spinal anesthesia can be challenging in patients undergoing total joint arthroplasty because of poorly palpable surface landmarks and age-related changes in the lumbar spine. We hypothesized that pre-procedural ultrasound imaging would be effective in identifying the lumbar intervertebral spaces and would provide an accurate measure of the depth to the intrathecal space. Methods Fifty patients undergoing elective total joint arthroplasty were recruited in this prospective descriptive study. Using a curved-array 2-5 MHz transducer, the lumbar spine was imaged in two views, i.e., longitudinal parasagittal (LP) and transverse midline (TM). The intervertebral levels were identified by counting upwards from the sacrum. The locations of the interlaminar spaces were identified by visualizing the ligamentum flavum-dura mater complex and the posterior aspect of the vertebral body. The needle insertion point for a midline approach was determined from the ultrasound examination and was marked on the skin of the patient's back. ResultsThe mean patient age was 67 ± 10 yr, and 46% of the patients had a body mass index [30 kg Á m -2 . Surface landmarks were difficult or impossible to palpate in 38% of the patients. The scan quality on the LP and TM views was adequate or better in 100 and 98% of the patients, respectively. Dural puncture was achieved with one needle insertion attempt and within two needle insertion attempts in 84% and 98% of the patients, respectively. The ultrasoundmeasured depth to the intrathecal space correlated well with the actual needle insertion depth (concordance correlation coefficient = 0.82, accuracy 0.95, precision 0.86), with a tendency to overestimate the depth by just 2.1 ± 5.4 mm. Conclusions Ultrasound imaging of the lumbar spine provides clinically useful information that can facilitate spinal anesthesia in the older orthopedic patient population.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty

Chin

Perlas

Singh

et al. 2009

Can J Anesth/J Can Anesth

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“…Previous studies demonstrated accuracy in 29-59% of subjects when attempting to identify lumbar interspaces by palpation [3][4][5][6][7][8][9] . Our success rate (67%) was higher than those smaller size studies.…”

Section: Discussionmentioning

confidence: 99%

“…Broadbent et al 6 assessed the accuracy of palpation using MRI in a study of 100 patients. Many studies have compared palpation to ultrasound imaging [7][8][9][10] . With lumbar radiograph as the standard, Furness et al 7 showed that the correct interspace was identifi ed in 71% of 50 cases using ultrasound, compared with a 30% success rate with palpation.…”

Section: Discussionmentioning

confidence: 99%

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Identificação dos espaços interespinhosos lombares por palpação e avaliados por radiografias

Tanaka¹,

Irikoma²,

Kokubo³

2013

Rev. Bras. Anestesiol.

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Background and objectives: Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using postoperative X-rays in obstetric patients. Methods: We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confi rmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentifi cation of interspinous level. Results: Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological defi cits. No variables evaluated were signifi cantly associated with misidentifi cation of interspinous level by the anesthesiologists. Conclusions: There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.

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Fundamentals

Capogna

2020

Epidural Technique in Obstetric Anesthesia

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Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia

Cited by 98 publications

References 16 publications

An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty

An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty

Identificação dos espaços interespinhosos lombares por palpação e avaliados por radiografias

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