Depth of extradural space and dural puncture

Sutton, Debbie; Linter, S.P.K.

doi:10.1111/j.1365-2044.1991.tb09348.x

Cited by 40 publications

(33 citation statements)

References 2 publications

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“…The incidence of unintentional dural puncture decreases with experience (8) and the approximate incidence of 0.8% over the 12-yr period of this review reflects the experience of trainees and staff with varying degrees of experience. This estimated incidence is similar to that reported (0.7%) in a large study in another institution (11). Compared to 500 consecutive women receiving epidural analgesia, women with a previous wet tap had a higher incidence of wet tap.…”

Section: Discussionsupporting

confidence: 85%

“…The lower incidence of catheter manipulation in women with previous wet tap compared to 500 consecutive women is noteworthy and may reflect the extra attention paid by faculty or residents. Similarly, the normal depth to the epidural space in these women (11) argues against an anatomic abnormality of a superficial epidural space as the cause for the original wet tap.…”

Section: Discussionmentioning

confidence: 95%

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Previous Wet Tap Does Not Reduce Success Rate of Labor Epidural Analgesia

Blanché

Eisenach

Tuttle

et al. 1994

Anesthesia & Analgesia

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Whether unintentional dural puncture (wet tap) during a previous labor epidural increases the failure rate of epidural analgesia for later deliveries is controversial. In this study, charts of 47 women with a previous wet tap who received epidural analgesia for labor were compared to those of 500 consecutive women receiving epidural analgesia in 1991 and, separately, to 44 women matched for month of delivery, previous epidural without a wet tap, and the same anesthesiologist. In comparison to the 500 consecutive control patients, women with a previous wet tap had a lower incidence of epidural catheter manipulation for inadequate block (9% vs 20%), but a similar incidence of catheter removal for failed block (4% vs 6.7%). In comparison to matched control patients, women with a previous wet tap had a similar incidence of epidural catheter manipulation and removal for inadequate or failed blocks. Epidural analgesia was considered successful in 93% of cases and 89% of matched control subjects by chart review. Two women (4%) with previous wet tap experienced a second wet tap during attempted epidural catheterization, compared to 0% in 500 consecutive patients (P < 0.001). These data suggest that there is no decrease in the success rate of epidural analgesia in women with a previous wet tap, although the chance for a repeated wet tap may be increased.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 95%

Previous Wet Tap Does Not Reduce Success Rate of Labor Epidural Analgesia

Blanché

Eisenach

Tuttle

et al. 1994

Anesthesia & Analgesia

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show abstract

“…The incidence of dural puncture is three times higher in patients with 2-4 cm of lumbar epidural space depth than in patients with 4 -6 cm of epidural depth. 22 For these reasons, we decided to perform the ultrasound examination and puncture only at the C6/7 level on all patients, allowing us to reduce the risk of dural puncture and more easily identify the dura mater.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Estimation of Needle Depth for Cervical Epidural Blocks

Kim¹,

Lee²,

Yoon³

et al. 2008

Anesthesia &Amp; Analgesia

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“…A curved-array transducer (2e5 MHz with Micromaxx system) was used for the scan. Ultrasound scanning (US) was preformed in the longitudinal paramedian plane [12] by a single investigator, who was experienced in US imaging of the spine and familiar with spinal sonoanatomy. The transducer was held in the nondominant hand of the operator, and it was positioned 1e2 cm lateral to the spinal processes.…”

Section: Methodsmentioning

confidence: 99%

Lumbar epidural space was narrower in parturients than that in nonpregnant women by ultrasound assessment

Huang

Hsu

et al. 2011

The Kaohsiung J of Med Scie

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Labor epidural is commonly used to provide both regional anesthesia and postoperative pain relief. Epidural space is supposed to be narrower and deeper in a parturient than that in a nonpregnant woman. The aim of this study was to explore the difference of epidural spaces between parturient and nonpregnant women by ultrasound assessment. Thirty nonpregnant female volunteers and 30 parturients undergoing labor epidurals were enrolled to receive ultrasound examination. A low-frequency (2-5 MHz) curved-array ultrasound probe was used to obtain spinal sonoanatomy for each subject. The longitudinal paramedian scanning plane was used to obtain optimal ultrasound image for spinal sonoanatomy. Primary outcome was evaluated by the diameter and depth of epidural space at three lumbar interspaces (from L2 to L5). The quality of ultrasound images was also compared between the groups by a numerical scoring system (from 0 to 3). The mean diameters of lumbar epidural spaces were 3.03 ± 0.45 mm and 4.44 ± 0.49 mm (p<0.05) for parturients and nonpregnant women, respectively. The mean depths of lumbar epidural spaces for parturients and nonpregnant women were 3.53 ± 0.62 cm and 3.25 ± 0.63 cm, respectively (p<0.05). The mean scores for epidural space image quality were 2.58 ± 0.58 and 2.63 ± 0.53 for parturients and nonpregnant women, respectively (p=0.08). Epidural space is narrower and deeper at lumbar interspaces in obstetrics by ultrasound examination. The quality of ultrasound images did not differ significantly between the groups. These quantitative results improve the understanding of the differences between two groups that have been previously known qualitatively and may help in avoiding complications.

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Depth of extradural space and dural puncture

Cited by 40 publications

References 2 publications

Previous Wet Tap Does Not Reduce Success Rate of Labor Epidural Analgesia

Previous Wet Tap Does Not Reduce Success Rate of Labor Epidural Analgesia

Sonographic Estimation of Needle Depth for Cervical Epidural Blocks

Lumbar epidural space was narrower in parturients than that in nonpregnant women by ultrasound assessment

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