Epidural Catheter Placement in Neonates: Sonoanatomy and Feasibility of Ultrasonographic Guidance in Term and Preterm Neonates

Willschke, Harald; Bösenberg, Adrian; Marhofer, Peter; Willschke, Julie; Schwindt, Jens; Weintraud, Marion; Kapral, Stephan; Kettner, Stephan C.

doi:10.1016/j.rapm.2006.10.008

Cited by 59 publications

(64 citation statements)

References 21 publications

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“…Prior ulltrasound evaluation is invaluable, but is really only clinically practical in infants and neonates before ossification of the vertebral column has occurred (Willschke et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

“…In the total sample, the conus medullaris was found below the level of L4 in two cases. Willschke et al (2007) conducted an extensive ultrasonographic study on 145 term-and preterm neonates undergoing epidural catheter placement. The authors' aim was to describe the sonographic anatomy of the epidural space of patients in this age group and include the skin-to-ligamentum flavum depth at various levels as well as the level of the conus medullaris.…”

Section: (3)mentioning

confidence: 99%

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Descriptive study of the differences in the level of the conus medullaris in four different age groups

2015

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INTRODUCTION:In performing neuraxial procedures, knowledge of the location of the conus medullaris in patients of all ages is important. The aim of this study was to determine the location of conus medullaris in a sample of 2 newborn/infant cadavers and sagittal MRIs of children, adolescents and young adults. MATERIALS AND METHODS: The subjects of both the samples were subdivided into four developmental stages. No statistical difference was seen between the three older age groups (p>0.05). A significant difference was evident when the newborn/infant stage was compared with the other, older stages (p<0.001 for all comparisons). RESULTS: In the newborn/infant group the spinal cord terminated most frequently at the level of L2/L3 (16%). In the childhood stage, the spinal cord terminated at the levels of T12/L1 and the lower third of L1 (21%). In the adolescent population, it was most often found at the level of the middle third of L1 and L1/L2 (19%). Finally, in the young adult group, the spinal cord terminated at the level of L1/L2 (25%). This study confirmed the different level of spinal cord termination between newborns/infants less than one year old and subjects older than one year. In this sample the conus medullaris was not found caudal to the L3 vertebral body, which is more cranial than the prescribed level of needle insertion recommended for lumbar neuraxial procedures. CONCLUSION: It is recommended that the exact level of spinal cord termination should be determined prior to attempting lumbar neuraxial procedures in newborns or infants.

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Section: Discussionmentioning

confidence: 99%

Section: (3)mentioning

confidence: 99%

Descriptive study of the differences in the level of the conus medullaris in four different age groups

2015

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“…In infants and neonates, ultrasound enables visualization of epidural catheters that are inserted via the easily accessible caudal space and threaded to the desired vertebral level in the thoracic or lumbar regions. [33][34][35] The availability of ultrasound to guide placement of caudal-thoracic epidurals has resulted in an increased use of epidural analgesia in infants during the last three years of this review.…”

Section: Discussionmentioning

confidence: 99%

Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Wong

Arab

Chew

et al. 2013

Can J Anesth/J Can Anesth

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Background Complications associated with epidural analgesia in children have a reported incidence of 40-90 in 10,000 epidurals. We sought to determine the incidence of major complications with the use of continuous epidural analgesia that occurred in our centre over the past 15 years and to describe the nature of these complications. Methods The Acute Pain Service database at a tertiary care academic pediatric hospital was reviewed retrospectively over a 15-year period. Data were categorized according to patient age (neonate, infant, child one through eight years, and child [ eight years), mode of insertion of the epidural (caudal, transsacral, lumbar, thoracic), complication type, and complication severity. Results Over the 15-year period, 3,152 epidurals were performed. The use of caudal-thoracic epidurals in neonates and infants has increased since 2007. Twenty-four major complications were identified (incidence, 7.6 in 1,000 epidurals). The rate of complications in neonates

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“…Furthermore, loss-of-resistance technique to identify the epidural space is difficult as the spinal ligaments are less fibrous. In a study on sixty neonates who received ultrasound guided block, good visibility of structures within the spinal canal, including the dura mater, ligamentum flavum and the termination of the spinal cord was reported [27].…”

Section: Ultrasound Guided Regional Blocks In the Neonatementioning

confidence: 99%

Regional Anaesthesia for the Neonate

Wadhwa¹,

Hasija²,

Saxena³

2017

J Neonat Surg

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Numerous regional and local anaesthesia techniques are available for safe use in neonates and can be administered either in combination with general anesthesia or in the awake neonate. Regional anaesthesia provides effective analgesia with reduced drug requirement which is especially beneficial in view of the immature physiology and metabolism in the neonate. The reduced requirement of anaesthetic drugs facilitates stable hemodynamics, faster recovery and a decreased length of stay in the neonatal intensive care unit.

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Epidural Catheter Placement in Neonates: Sonoanatomy and Feasibility of Ultrasonographic Guidance in Term and Preterm Neonates

Cited by 59 publications

References 21 publications

Descriptive study of the differences in the level of the conus medullaris in four different age groups

Descriptive study of the differences in the level of the conus medullaris in four different age groups

Major complications related to epidural analgesia in children: a 15-year audit of 3,152 epidurals

Regional Anaesthesia for the Neonate

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