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

Abstract

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.

The use of ultrasound for lumbar spinous process identification: A pilot study

“…In addition, using ultrasound may also reduce the number of attempts to place the block, thus improving patient satisfaction. 5,16,17 Recent studies in parturients who received epidural analgesia showed that the distance from the skin to the epidural space can be measured accurately in both normal and obese patients. 18,19 This may reduce the risk of accidental dural puncture.…”

A Systematic Review Of Neuraxial Anesthesia In Patients With Ankylosing Spondylitis

“…[14,22] Preoperative imaging with ultrasound may be useful in the application of spinal anesthesia and selection of anesthesia methods. [28,29] Therefore, the use of imaging techniques is likely to be helpful for patients with AS when NAA application is expected to be difficult. The use of ultrasound in NAA has been recently suggested.…”

“…The use of ultrasound in NAA has been recently suggested. [28] The advantages of easy positioning and absence of radiation exposure make USG preferable to fluoroscopy. However, USG was performed in only one patient in the literature we assessed, suggesting that there remains a great opportunity for preoperative assessment and application of USG in NAA for patients with AS.…”

The use of an online three-dimensional model improves performance in ultrasound scanning of the spine: a randomized trial

“…The application of ultrasound technology provides some benefits to visualization of landmarks that are difficult to feel with surface anatomy in the presence of obesity or spinal abnormalities. 6,7 It also facilitates identifying the correct lumbar interspaces, as it has been shown repeatedly that palpation of the spine for identification of a particular lumbar vertebra is inaccurate even with experienced practitioners. [8][9][10] Nevertheless, teaching the use of ultrasound in guiding neuraxial blockade can be challenging, as new knowledge must be learned and new skills must be acquired.…”