Evaluation of pre-procedure ultrasound examination as a screening tool for difficult spinal anaesthesia*

Abstract

Summary We performed a pre‐procedure ultrasound examination of the spine on 60 patients undergoing lower extremity orthopaedic surgery under spinal anaesthesia. We hypothesised that the inability to identify the posterior longitudinal ligament or vertebral body easily with ultrasound would be associated with difficulty placing a spinal anaesthetic. Clinicians blinded to the ultrasound scan performed the injections using the traditional landmark technique. The spinal procedure was videotaped and subsequently reviewed by independent investigators. We defined procedure difficulty by total procedure time (> 400 s) and number of needle passes (≥ 10) required to achieve return of cerebrospinal fluid, or abandonment of the procedure due to unsuccessful dural puncture. When images of the posterior longitudinal ligament were poor (low score group), the mean (SD) number of passes was 21.2 (30.6), compared with 4.8 (7.5) with good ultrasound images (high score group) (p < 0.01). The mean (SD) time for placement was 420 (300) s in the low score group vs 176 (176) s in the high score group (p < 0.01). You can respond to this article at http://www.anaesthesiacorrespondence.com

Ultrasonography Guided Spinal Anesthesia in a Case With Severe Kyphoscoliosis

“…Chin et al (10) identified the interlaminar spaces visualizing by ligamentum flawum-dura mater complex and the posterior aspect of the vertebral body in their US assisted approach for spinal anesthesia in joint arthroplasty cases in the elderly and they suggested it could facilitate spinal anesthesia in patients had age related changes in lumbar spine. Weed et al (11) in their pre-procedure US screening for spinal anesthesia study demonstrated that the good images of the posterior longitudinal ligament is a reliable indicator for a suitable window to the intratecal space and they emphasized that ultrasound can play in the decision making process. In the present case, we relied on the information obtained from the ultrasound and performed the spinal anesthesia.…”

Acoustic shadowing from neuraxial bone

“…We thank Drs Ma and Gray for their interest in our article [1]. We appreciate the information they provide on ultrasound reverberation artifact, specifically as it pertains to bony structures in the lumbar and sacral areas.…”

“…Tramadol is a centrally acting analgesic with affinity for opioid receptors that rarely causes respiratory depression [1]. It also provides analgesia through inhibition of serotonin and noradrenaline reuptake.…”

“…Great care and some experience is required to optimise all steps of central venous catheterisation and too much emphasis on an individual step may overshadow other equally important elements of the procedure. [1]. They reported an association between the lack of ability to identify an acoustic window between adjacent laminae of the lumbar spine and subsequent difficulty with injections for spinal anesthesia.…”

http://www.medultrason.ro/ultrasound-in-the-examination-of-the-gallbladder-a-holistic-approach-grey-scale-doppler-ceus-elastography-and-3d/

“…If one can see both AC and PC in TM view, it indicates that there is a clear path for the US beam to pass, and hence the likelihood of inserting a spinal or epidural needle into the intended space is higher. Multiple scoring systems have been developed to assess the degree of difficulty in any given inter-spinous space [39] but the bottom line is to select the inter-spinous space with the best possible TM view of AC and PC.…”