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Purpose In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects

Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle.

Canadian journal of anaesthesia = Journal canadien d'anesthésie, no. 4 (2010): 313-321

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摘要

In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects. Thereafter, the correct passage of the needle towards the epidural space is a blind "feel as you go" method. An aim-and-insert s...更多

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简介
  • In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects.
  • Method Nineteen subjects undergoing elective Cesarean delivery consented to undergo both a pre-puncture ultrasound scan and real-time paramedian ultrasound-guidance for needle insertion.
  • Following were the study objectives: to measure the success of a combined spinal-epidural needle insertion under real-time guidance, to compare the locations of the chosen interspinous levels as determined by.
重点内容
  • Purpose In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects
  • Entry into the epidural space was not achieved despite ultrasound guidance
  • Needle insertion is performed using the loss-of-resistance to saline/air, which is a ‘‘feel as you go’’ method to ensure a proper track toward the ligamentum flavum and epidural space
  • Combined spinal-epidural using a Tuohy epidural needle were noted as having similar rates of failure, i.e., 16%,15 25%,16 and 18%10 rates of absence of cerebrospinal fluid aspirations were reported
方法
  • Subject selection

    This study was approved by the Children and Women’s Health Centre of British Columbia and the University of British Columbia’s clinical research ethics boards (CW050262 / H05-70409).
  • The subjects were recruited throughout March 2008 to May 2008 using informed written consent.
  • The subjects’ age, weight, and height were collected and the body mass index was calculated.
  • As this is a feasibility study, test subjects were those scheduled for Cesarean delivery so that labour pains did not disrupt the time or subject stability needed to learn the new technique.
  • A sample size of 20 was chosen because a minimum of ten subjects was found to give an 85% success rate[4] for other ultrasound guidance studies, and given the nature of the study, the authors recruited 20 subjects to allow for a more robust statistical analysis
结果
  • One subject did not participate in the study because pre-puncture ultrasound examination showed unrecognizable bony landmarks.
  • Subject Age Weight Height Epidural space: LOR Comments about success obtained with of overall procedure ultrasound guidance Yes No. Loss-of-resistance to saline could not be elicited.
  • The authors' rates of absence of CSF in subjects where loss-of-resistance was felt (4/18) were comparable with previous studies, with the added difficulty of performing the needle-through-needle technique in the paramedian plane.[14] In previous studies, CSEs using a Tuohy epidural needle were noted as having similar rates of failure, i.e., 16%,15 25%,16 and 18%10 rates of absence of CSF aspirations were reported
结论
  • This small study demonstrates the feasibility of the ultrasound-guidance technique. Areas for further development are identified for both ultrasound software and physical design.

    Resume Objectif Dans le positionnement traditionnel de l’aiguille peridurale, l’identification du niveau interepineux et le choix du site de ponction se fondent sur la palpation de points de repere anatomiques, ce qui peut s’averer difficile chez certains patients.
  • Chez 18 des 19 patientes, l’aiguille peridurale a bien eteinseree dans l’espace peridural tel que defini par une perte de resistance.
  • Epidural needle placement is performed most commonly using an anatomical landmark-based technique for identifying the chosen intervertebral level and site of insertion.
  • This procedure can be difficult for some subjects, such as the obese.
  • Loss-of-resistance to saline/air is the gold standard method for identifying entry into the epidural space.[1]
表格
  • Table1: Subject biometrics and comments
  • Table2: Palpation compared with ultrasound: difference (mm) between the anesthesiologist’s mark and the sonographer’s mark. Data missing due to time constraints are labelled ‘‘n/a’’
Download tables as Excel
基金
  • This work was supported by a Collaborative Health Research Project jointly funded by the Canadian Institutes for Health Research and the Natural Sciences and Engineering Research Council
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