Prospective observational investigation of body habitus measurements and relationship to epidural depth in term pregnant women

Abstract

Background High body mass index (BMI) can predict difficult neuraxial block; however, fat distribution may also be important. The primary study aim was to identify body habitus and fat distribution measurements that correlated with ultrasound measured epidural depth. We hypothesized that measurements such as midarm and subscapular fatpad thicknesses and length of cervical spine may correlate better with ultrasound measured epidural depth than a global measure of BMI. Methods Prospective IRB approved study of term pregnant women requiring neuraxial block. We measured height, weight (BMI, kg/m2), subscapular, midarm fatpad thickness (digital caliper, mm), vertebral column length (C7 to sacral hiatus, cm) and epidural depth (ultrasound, mm). Four experts assessed photographs to assign anticipated difficult neuraxial block in sitting and lateral positions (5‐point Likert scale, 1 = very easy, 5 = very difficult). Results In all, 131 women completed body habitus measurements. Measured mean (standard deviation) BMI was 30.3 (5.4) kg/m2. Measured BMI, subscapular fatpad and midarm fatpad thickness were significantly correlated with ultrasound depth to epidural space (R2 0.733, 0.626 and 0.633, respectively, P < .0001) but vertebral column length was not. The experts had a high level of agreement (Cronbach's alpha >0.7) for assessment of anticipated difficult block in the sitting and lateral positions; however, anticipated difficult block was not correlated with epidural depth measured by ultrasound for sitting position, R2 = −0.015, P = .87; and lateral position, R2 = −0.087, P = .33. Conclusions Measurements of body habitus and fat distribution were no better than measured BMI to anticipate greater ultrasound measured depth to epidural space. Clinical trial number: Non‐interventional observational study, not registered.

Labour epidural practice in a tertiary training centre

“…Factors that could be explored include body habitus pre-pregnancy, truncal or central obesity, and level of physical activity. 9 Future prospective studies on comparison of rates of complication need to consider matching the level of expertise of proceduralists for the various ethnicities or when comparing the nationalities within the same ethnicities. 10 Decisions for offering opportunities for trainees (on who does the epidural) in "difficult epidurals" should be made from direct assessment of surface anatomy or sono-visualisation (present spinal ultrasound rate is <10%), 7 and by actual palpability of patients' lumbar spine.…”