Predicting the Difficult Neuraxial Block

Development and Evaluation of a Score to Predict Difficult Epidural Placement During Labor

“…Based on a prevalence of DEP of 30%, 105 events were expected with half of the events in the training set and half in the validation set. 6,7 Because 5 candidate variables were tested in the training set, it would lead to a ratio of the number of events to the number of candidate variables greater than 10 on multivariable analysis.…”

“…18 Palpation of interspinous spaces was classified as good when easily palpable, poor when hardly palpable, and nil when impalpable. 6,7,9,10 Interspinous space palpation was defined difficult for palpation scores of poor or nil.…”

“…19 Spinal deformity was defined as deviation from the midline of the visible or palpated spinal processes, as previously reported. 6,7,9,10 The ability of the patient to flex her spine was observed by standing at the patient's side and asking her to flex her back to a maximum. 7,9 The curvature of the skin was recorded as either convex, straight, or concave.…”

Regional anesthesia and pain medicine: Residency training[mdash ]the year 2000☆

“…Although only 75% of residents are confident with performance of thoracic epidural catheters at the end of residency (compared with 100% for lumbar epidural placement), 7 we suspect that placement of epidural catheters in the thoracic region has markedly increased. Because of increased faculty anesthesiologist familiarity/ training and ease of performance, 8 we feel the use of thoracic epidural anesthesia will continue to increase over the next decade. Furthermore, we suspect that lumbar epidural placement remains the primary location for pain management and OB, but that the thoracic region may be the principal location for epidural placement in the general operating room setting.…”

Spinal Anesthesia for Orthopedic Surgery

“…The primary patient-related reason for procedural difficulty is likely secondary to anatomical pathology related to osteoarthritis, degenerative disease, previous back surgery, or obesity. 6,12 Given that the standard technique mandates the inference of correct needle insertion by palpating surface landmarks, the operator has no knowledge of anatomical barriers to successful needle insertion. Therefore, repeated and varied needle insertions may be necessary to identify needle trajectories that are unimpeded to the thecal sac.…”