Preprocedural Ultrasound Estimates of Epidural Depth: Transverse Median Plane is Comparable to Paramedian Sagittal Oblique Plane in Non-Pregnant Patients

Cantürk, Mehmet; Kocaoğlu, Nazan; Hakki, Meltem

doi:10.5152/tjar.2019.92342

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…The comparable results were observed in the studies by Canturk et al . [ 6 12 ] in parturients and non-parturients, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Correlation of preprocedural ultrasound estimated epidural depths in transverse median and posterior sagittal oblique view and body mass index with procedural epidural depths in patients scheduled for surgery under lumbar epidural anaesthesia

Rana¹,

Awasthi²,

Verma³

et al. 2021

Indian J Anaesth

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Background and Aims: Preprocedural lumbar ultrasound (US) is employed for the estimation of epidural depth (ED). This study observed the correlation of preprocedural ED in transverse median (TM), parasagittal oblique (PSO) view, and body mass index (BMI) with procedural ED. Methods: In a prospective study, 100 female patients, aged 40–65 years, with American Society of Anesthesiologists physical status I/II, BMI 18.5–30 kg m− 2 scheduled for surgeries under lumbar epidural blocks were included. In the TM group, preprocedural ultrasonography (USG) was performed in TM view and ED was calculated, whereas in the PSO group, the paramedian sagittal view was used and corresponding markings were done for epidural needle insertion in the midline and paramedian planes, respectively. The primary outcome was the correlation of procedural ED and preprocedural ED in TM and PSO views, respectively. The secondary outcomes included correlation of procedural ED with BMI, comparability of preprocedural, and procedural ED in TM and PSO views. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v19.0 (International Business Machines, USA). Results: The preprocedural and procedural ED was less in the TM group (4.43 ± 0.75 and 4.44 ± 0.75 cm) in comparison to those in the PSO group (4.86 ± 0.53, 4.90 ± 0.54; P = 0.001). Strong correlation was observed in preprocedural and procedural ED [r 2 = 0.996 and 0.995]. The procedural ED had strong correlation with BMI [r 2 = 0.600, P = 0.001] in the TM group, and weak correlation [r 2 = 0.367] in the PSO group [ P = 0.01]. The procedural ED was comparable to preprocedural ED in TM and PSO groups. Conclusion: Preprocedural US scanning provides an accurate estimate of actual EDs in TM and PSO view.

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“…The comparable results were observed in the studies by Canturk et al . [ 6 12 ] in parturients and non-parturients, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Our study findings are in concordance with the study by Canturk et al . [ 12 ] showing a strong positive correlation between the USG measured ED and procedural needle depth. Moreover, Khemka et al .…”

Section: Discussionmentioning

confidence: 99%

Correlation of preprocedural ultrasound estimated epidural depths in transverse median and posterior sagittal oblique view and body mass index with procedural epidural depths in patients scheduled for surgery under lumbar epidural anaesthesia

Rana¹,

Awasthi²,

Verma³

et al. 2021

Indian J Anaesth

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Correlation between epidural space depth measured with ultrasound and MRI compared to clinical loss of resistance when performing lumbar epidural steroid injection

Singh,

Pritzlaff,

Bautista

et al. 2024

Reg Anesth Pain Med

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BackgroundThis prospective study assessed the accuracy of MRI and ultrasound (US) measurements as a preprocedural assessment tool for predicting clinical loss of resistance depth (CLORD) during fluoroscopy-guided lumbar epidural steroid injections (ESIs).Materials and methodsSixty patients enrolled received lumbar ESIs at an academic chronic pain clinic. The MRI measurement calculated the distance between the skin and the posterior epidural space, while US measurements included transverse and parasagittal oblique views of the interlaminar space. The epidural space measurements were compared with the CLORD during the performance of the prone epidural injections. The differences in measurements were analyzed using two one-sided tests for equivalency with a 0.5 equivalency margin. The intraclass correlation coefficients between CLORD and the imaging modalities were estimated using mixed effects models.ResultsMRI was equivalent to CLORD with a mean difference of –0.2 cm (95% CI –0.39 to –0.11). US transverse and US parasagittal oblique measurements were not equivalent to and underestimated CLORD with mean differences of –0.98 cm (90% CI –1.8 to –0.77) and –0.79 cm (90% CI −1.0 to −5.9), respectively. The intraclass correlation coefficients between MRI and CLORD were the highest at 0.85, compared with 0.65 and 0.73 for transverse and parasagittal oblique US views, respectively.ConclusionsMRI measurements are preferable over US for preprocedural assessment of patients receiving lumbar ESIs for predicting CLORD.

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Ultrasound estimates of the epidural depth in the paramedian sagittal oblique and transverse median planes: the correlation between estimated and actual depth to the epidural space in children with scoliosis

Choi,

Jang,

Kim

et al. 2023

Reg Anesth Pain Med

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IntroductionThe present study aimed to compare the correlation and agreement of epidural depth estimation using ultrasound in the paramedian sagittal oblique (PSO) versus the transverse median (TM) plane relative to the actual epidural depth observed during midline epidural punctures in children with scoliosis.MethodsIn this prospective observational study, we enrolled 55 children aged 3–14 years with thoracolumbar scoliosis (Cobb angle >10°) requesting postoperative epidural analgesia. Ultrasound imaging was performed to estimate the distance from the skin to the epidural space in the bilateral PSO and TM planes. An anesthesiologist performed midline epidural puncture and measured the actual epidural depth from the skin to the epidural space. The correlation and degree of agreement between the ultrasound-estimated and actual epidural depths were investigated using Pearson’s and concordance correlation coefficients. The image quality of the ligamentum flavum and posterior dura mater was compared.ResultsIn the PSO view, where the larger of the two measurements from both sides was used, both Pearson’s and concordance correlation coefficients for comparing the actual epidural and ultrasound-estimated depths were significantly higher than those in the TM view (0.964 vs 0.930, p value=0.002; 0.952 vs 0.892, p value=0.004, respectively). The ligamentum flavum-posterior dura mater unit was more easily distinguished in the PSO view than in the TM view (72.7% vs 38.2%, p value<0.001).ConclusionsThe PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization.Trial registration numberNCT04877964.

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Preprocedural Ultrasound Estimates of Epidural Depth: Transverse Median Plane is Comparable to Paramedian Sagittal Oblique Plane in Non-Pregnant Patients

Cited by 3 publications

References 29 publications

Correlation of preprocedural ultrasound estimated epidural depths in transverse median and posterior sagittal oblique view and body mass index with procedural epidural depths in patients scheduled for surgery under lumbar epidural anaesthesia

Correlation of preprocedural ultrasound estimated epidural depths in transverse median and posterior sagittal oblique view and body mass index with procedural epidural depths in patients scheduled for surgery under lumbar epidural anaesthesia

Correlation between epidural space depth measured with ultrasound and MRI compared to clinical loss of resistance when performing lumbar epidural steroid injection

Ultrasound estimates of the epidural depth in the paramedian sagittal oblique and transverse median planes: the correlation between estimated and actual depth to the epidural space in children with scoliosis

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