Skip to main content
SpringerLink
Log in

Feasibility of ultrasound-guided lumbar epidural access using paramedian transverse scanning with the needle in-plane: a comparison with paramedian sagittal scanning

  • Original Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Background and objectives

The present study was designed to compare the feasibility of ultrasound (US)-guided lumbar epidural access using paramedian sagittal scanning (PMSS) and paramedian transverse scanning (PMTS) approaches.

Methods

Fifty patients undergoing surgery of the lower extremities were randomly allocated into 2 groups. The patients in PMSS group received PMSS-guided in-plane epidural access, whereas patients in PMTS group received PMTS-guided in-plane epidural access. The US visibility of neuraxial structures and of Tuohy needle during US scout scan, procedure duration, the number of attempts to access epidural space, Tuohy needle puncture depth in the epidural space, and extent of sensory block after spinal block between two groups were compared.

Results

The US visibility of Tuohy needle and neuraxial structures was comparable between two groups. There was an overall decrease in procedure duration in the PMTS group relative to the PMSS group (360 ± 42 vs. 490 ± 38 s). The number of attempts needed to access the epidural space in PMSS group was significantly higher than in PMTS group. Distances between the epidural space and the puncture site in PMSS group and PMTS group showed a significant difference (7.13 ± 0.67 vs. 5.24 ± 0.21 cm). No significant differences in the extent of sensory block after spinal block were observed.

Conclusions

We found that PMTS approach was superior as a means of achieving epidural access relative to the PMSS approach, since PMTS approach can be conducted more quickly given shorter path of the needle and less times needed for epidural access during this procedure.

Clinical trial registration

Chinese Clinical Trial Registry, clinical trial number ChiCTR1800015815, date of registration April 24, 2018.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chauhan AK, Bhatia R, Agrawal S. Lumbar epidural depth using transverse ultrasound scan and its correlation with loss of resistance technique: a prospective observational study in Indian population. Saudi J Anaesth. 2018;12:279–82.

    Article  Google Scholar 

  2. Arzola C, Mikhael R, Margarido C. Spinal ultrasound versus palpation for epidural catheter insertion in labour: a randomised controlled trial. Eur J Anaesth. 2015;32:499–505.

    Article  Google Scholar 

  3. Ecimovic P, Loughrey JPR. Ultrasound in obstetric anaesthesia: a review of current applications. Int J Obstet Anesth. 2010;19:320–6.

    Article  CAS  Google Scholar 

  4. Broadbent CR, Maxwell WB, Ferrie R. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia. 2015;55:1122–6.

    Article  Google Scholar 

  5. Grau T, Leipold RW, Fatehi S. Real-time ultrasonic observation of combined spinal-epidural anaesthesia. Eur J Anaesthesiol. 2004;21:25–31.

    CAS  PubMed  Google Scholar 

  6. Shaikh F, Brzezinski J, Alexander S. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ. 2013;346:f1720.

    Article  Google Scholar 

  7. Lim YC, Choo CY, Tan KTJ. A randomised controlled trial of ultrasound-assisted spinal anaesthesia. Anaesth Intensive Care. 2014;42:191–8.

    Article  CAS  Google Scholar 

  8. Grau T, Leipold RW, Conradi R. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169–75.

    Article  Google Scholar 

  9. Chin A, Crooke B, Heywood L. A randomised controlled trial comparing needle movements during combined spinal-epidural anaesthesia with and without ultrasound assistance. Anaesthesia. 2018;73:466–73.

    Article  CAS  Google Scholar 

  10. Srinivasan KK, Leo AM, Iohom G. Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: is this better than landmark-guided midline approach? A randomised controlled trial. Indian J Anaesth. 2018;62:53–60.

    Article  Google Scholar 

  11. Conroy PH, Luyet C, Mccartney CJ. Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach. Anesthesiol Res Pract. 2012;2013:525818.

    Google Scholar 

  12. Vallejo MC, Phelps AL, Singh S. Ultrasound decreases the failed labor epidural rate in resident trainees. Int J Obstet Anesth. 2010;19:373–8.

    Article  CAS  Google Scholar 

  13. Carvalho JC. Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin. 2008;26:145–58.

    Article  Google Scholar 

  14. Karmakar MK, Li X, Ho AM. Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. Br J Anaesth. 2009;102:845–54.

    Article  CAS  Google Scholar 

  15. Gnaho A, Nau A, Gentili ME. Real-time ultrasound-guided epidural catheter insertion in obese parturients. Obst Anesth Digest. 2016;36:161.

    Article  Google Scholar 

  16. Wang Y, Wang G, Ma D. Real-time ultrasound-guided paramedian epidural access using a paramedian transverse oblique scan: a prospective case series. J Anesth Perioper Med. 2018;5:70–6.

    Article  Google Scholar 

  17. Chin KJ, Perlas A, Chan V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011;115:94–101.

    Article  Google Scholar 

  18. Chin KJ, Karmakar MK, Peng P. Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade. Anesthesiology. 2011;114:1459–85.

    Article  Google Scholar 

  19. Legrand E, Chappard D, Pascaretti C. Trabecular bone microarchitecture, bone mineral density, and vertebral fractures in male osteoporosis. J Bone Miner Res. 2000;15:13–9.

    Article  CAS  Google Scholar 

  20. Saleem S, Aslam HM, Rehmani MA. Lumbar disc degenerative disease: disc degeneration symptoms and magnetic resonance image findings. Asian Spine J. 2013;7:322–34.

    Article  Google Scholar 

  21. Norris MC, Grieco WM, Borkowski M. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg. 1994;79:529–37.

    Article  CAS  Google Scholar 

  22. Cook TM. Combined spinal-epidural techniques. Anaesthesia. 2000;55:42–644.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported by Fostering Program for High-level Health and Technical Personnel in Beijing (Discipline Backbone) (No. 2013-3-018) to Dr. Yun Wang.

Author information

Author notes

  1. Huili Li and Yi Kang contributed equally to the work.

Authors and Affiliations

  1. Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, No. 8, Gongtinan Road, Chaoyang District, Beijing, 100020, China

    Huili Li, Danxu Ma, Yang Liu & Yun Wang

  2. Department of Pharmaceutical Science, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China

    Yi Kang

  3. Department of Anesthesiology, Miyun Hospital, Beijing, China

    Li Jin

Authors
  1. Huili Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yi Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Li Jin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Danxu Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yun Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HL, YK, LJ, DM, YL, and YW report no disclosures. YW was responsible for study design and performed the procedures. HL and YK contributed equally to this work including protocol design, data acquisition, data analysis, and manuscript drafting. DM and LJ were involved in writing the manuscript. YL and HL were involved in selecting appropriate patients and revising the article critically. All the authors approved the final version of the manuscript.

Corresponding author

Correspondence to Yun Wang.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (AVI 76670 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, H., Kang, Y., Jin, L. et al. Feasibility of ultrasound-guided lumbar epidural access using paramedian transverse scanning with the needle in-plane: a comparison with paramedian sagittal scanning. J Anesth 34, 29–35 (2020). https://doi.org/10.1007/s00540-019-02704-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-019-02704-7

Keywords

Search

Navigation