Color your epidural: color flow Doppler to confirm labor epidural needle position

Riveros-Pérez, Efraín; Albo, Camila; Jimenez, Enoe; Cheriyan, Thomas; Rocuts, Alexander

doi:10.23736/s0375-9393.18.13175-0

Cited by 11 publications

(8 citation statements)

References 30 publications

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“…However, this cannot be directly extrapolated to assessment of a catheter in the lumbar epidural space. Our results are also different from previous case series regarding color flow Doppler in lumbar epidural catheters, in which Riveros-Perez et al 10 and Elsharkawy et al 9 visualized the epidural catheter tip at the posterior complex in 37% and 68%, respectively. There are two reasons that may explain this difference.…”

Section: Discussioncontrasting

confidence: 99%

“…This adheres to the recommendation to recruit at least 30 subjects to estimate a parameter in a proof-of-concept study 13. Furthermore, this sample size exceeds the previous, retrospective studies on this topic 9 10…”

Section: Methodsmentioning

confidence: 91%

“…However, little is known about its potential to confirm the position of a sited epidural catheter. Recent retrospective case series have proposed color flow Doppler sonography to determine catheter tip position 9 10. Their results, however, showed limited success, visualizing the catheter tip in only 37%–68% of patients with adequate epidural analgesia.…”

Section: Introductionmentioning

confidence: 99%

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Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Bosch

Gleicher

Arzola

et al. 2022

Reg Anesth Pain Med

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BackgroundUltrasound is commonly used to facilitate epidural catheter placement. However, data are lacking regarding its potential to confirm its position in the epidural space. Our aim was to visualize flow in the epidural space of patients receiving epidural analgesia for labor using color flow Doppler ultrasound.MethodsWe conducted a prospective observational cohort study that included patients who had delivered vaginally under epidural analgesia. We used a 5–2 mHz curvilinear probe in a left and right paramedian longitudinal oblique view to visualize the anterior and posterior complex at the interspace of epidural catheter insertion, one and two interspaces above and below. At each window, the color flow Doppler function was used to visualize flow within the epidural space on injection of normal saline (1 mL). If no flow was visualized at any interspace, one assessment at the level of insertion was repeated with a 1 mL air/saline mixture. We studied a convenience sample size of 40 patients.ResultsWe visualized flow in the epidural space in all 40 patients. Flow was visualized on injection of 1 mL of saline in 37/40 patients (93%). In the remaining 3/40 patients (7%), flow was visualized with an air/saline mixture. Flow on injection of saline was visualized only at the interspace of insertion in 26/37 patients (70%), at the interspace of insertion and one interspace above in 10/37 (27%), or only at one interspace above in 1/37 (3%). Flow was visualized only on the left or on the right paramedian view in 19/37 patients (51%), despite a symmetrical sensory block in all patients.ConclusionColor flow Doppler ultrasound is a feasible and fast way to determine flow in the epidural space in the obstetric population. Its potential clinical uses are confirmation of the epidural catheter position after placement, as well as troubleshooting of unsatisfactory epidural analgesia. Interestingly, our results suggest that epidural catheters predominantly remain at the interspace of insertion.Trial registration numberNCT05126745.

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Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Bosch

Gleicher

Arzola

et al. 2022

Reg Anesth Pain Med

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“…Riveros-Perez et al introduced color Doppler imaging to confirm the correct position of the epidural needle in the lumbar spine [ 23 ]. However, this method has not been applied to CEDI [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Direct Visualization of Cervical Interlaminar Epidural Injections Using Sonography

Maeda¹,

Maeda²,

Tanaka

2022

Tomography

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In this case series, we describe a novel ultrasound (US)-guided cervical interlaminar epidural steroid injections (CILESIs) procedure that does not depend on the loss-of-resistance method for epidural space identification. A needle is introduced into three US-identified structures (triple bar sign), the interspinal ligament, ligamentum flavum, and dura mater. The injectants are monitored using superb microvascular imaging during injection. Here, we demonstrate the use of US-guided CILESIs in nine cases and propose the use of sonography, rather than conventional methods, for easier and safer cervical epidural injections. Sonography for direct visualization of cervical epidural injection may allow for outpatient injections.

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“…detectan en el 77 % de pacientes obstétricas la punta de la aguja de Touhy en el espacio epidural mediante la inyección de un flush de suero fisiológico y la correspondiente imagen doppler color producida, de manera similar a lo realizado en nuestro estudio. La colocación de la aguja de Touhy en este trabajo fue hecha de manera ecoasistida (13). Soon y cols.…”

Section: Discussionunclassified

Inyección epidural interlaminar ecoguiada de esteroides: evaluación de rendimiento mediante el método de la suma acumulativa (CUSUM)

Schwartzmann Bruno,

Surbano Silva,

San Millán Saánchez

et al. 2022

Rev. Soc. Esp. Dolor.

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Color your epidural: color flow Doppler to confirm labor epidural needle position

Cited by 11 publications

References 30 publications

Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Color flow Doppler in spinal ultrasound: a novel technique for assessment of catheter position in labor epidurals

Direct Visualization of Cervical Interlaminar Epidural Injections Using Sonography

Inyección epidural interlaminar ecoguiada de esteroides: evaluación de rendimiento mediante el método de la suma acumulativa (CUSUM)

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