Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique. Issue 9 (13th March 2019)

• Record Type: Journal Article
• Authors: Elsharkawy, Hesham; Saasouh, Wael; Babazade, Rovnat; Soliman, Loran Mounir; Horn, Jean-Louis; Zaky, Sherif
• Is Part Of: Pain medicine. Volume 20:Issue 9(2019)
• Page Start: 1750
• Page End: 1755
• Publication Date: 2019-03-13
• Subjects: Anesthesia -- Epidural -- Ultrasound Imaging; Pain -- Periodicals; Pain -- Treatment -- Periodicals; Analgesics -- Periodicals; Pain -- Periodicals; Pain Management -- Periodicals; Douleur -- Périodiques; Douleur -- Traitement -- Périodiques; Analgésiques -- Périodiques; Analgésique; Soulagement de la douleur; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.047205
• DOI: 10.1093/pm/pnz026
• Languages: English
• ISSNs: 1526-2375

Abstract

Abstract: Objective: The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design: Prospective descriptive trial on a novel approach. Setting: Operating room and preoperative holding area at a tertiary care hospital. Subjects: Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods: Consented adult patients aged 30–80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2–5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results: Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions: We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.