Ultrasound-guided spinal anesthesia for cesarean section in a parturient with spinal metastases

Abstract

Preprocedural spinal ultrasound appears to decrease the failure rate and complications of neuraxial anesthesia compared to the conventional landmark technique. It is especially beneficial in difficult cases where conventional palpation technique may fail. We recently encountered a parturient with multiple lumbar and cervical spinal metastatic lesions presenting for cesarean section in the third trimester. We used spinal ultrasound to define the appropriate intervertebral space and measure the distance to the ligamentum flavum-dura mater complex. This greatly helped in administering a safe spinal anesthetic and avoiding general anesthesia which might have been hazardous in this patient.

Ultrasonography versus palpation for spinal anesthesia in obese parturients undergoing cesarean delivery: a randomized controlled trial

“…The results of this study should not underestimate the benefits of lumbar spinal ultrasonography. In our practice, we commonly use ultrasonography in patients with impalpable landmarks, after multiple failed attempts with the palpation technique and in patients with significant spinal deformities or pathologies 28. In recent years, we have incorporated lumbar spinal ultrasonography in the teaching program of our residents and observed an improvement in the understanding of the lumbar spinal anatomy and its clinical applications (eg, properly locating the intervertebral levels and predicting the depth to the epidural and intrathecal spaces).…”