The ultrasound‐assisted paraspinous approach to lumbar neuraxial blockade: a simplified technique in patients with difficult anatomy

Abstract

Pre-procedural ultrasound imaging of the spine to identify the interspinous and interlaminar space has been shown to facilitate subsequent performance of lumbar neuraxial blockade. However, adequate visualization of the vertebral canal can be challenging for less-experienced operators, and particularly in subjects with difficult anatomy. In this case report, we describe a simplified technique of ultrasound-assisted neuraxial blockade that addresses these limitations and may thus be a useful fallback option. A pre-procedural scan is performed in which the main ultrasonographic landmarks to be identified are the neuraxial midline and the spinous processes, rather than the posterior and anterior complexes of the vertebral canal. Another key difference is the use of a paraspinous (or paramedian) needle approach rather than a midline approach that is advantageous where the interspinous spaces are narrowed by disease or suboptimal patient positioning. The anatomical basis and technical performance of this novel ultrasound-assisted paraspinous approach are presented in detail.

Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

“…The ultrasound-assisted CSE anesthesia technique provides improved precision and efficacy, overcoming the technical difficulties of performing neuraxial blocks [13][14][15][16][17] for obese [18,19], obstetric [20][21][22][23], and aged patients [12,24,25], as well as patients with difficult-todetect and abnormal anatomical surface landmarks [9,26]. However, few studies have focused on ultrasoundassisted CSE anesthesia in elderly patients who have difficulty achieving optimal body positioning.…”

Ultrasound-guided lumbar central neuraxial block

“…In patients with narrowed interspinous spaces, a paramedian needle approach may be required for successful entry into the epidural/intrathecal space. The use of ultrasound to facilitate a paramedian ( paraspinous) approach has recently been described, 3 and this technique may also be used where a satisfactory TI view cannot be obtained.…”

Comparing between ultrasound-assisted epidural catheter placement using Accuro and the use of ultrasound real time with acoustic puncture-assisted device to confirm epidural space end point

“…May also increase safety by decreasing the risk of traumatic procedures [8][9][10] Chin KJ described the use of pre-procedural ultrasound to facilitate a paramedian (paraspinous) approach. The paramedian needle approach may be required in patients with narrow interspinous spaces or if a satisfactory Transverse interlaminar/interspinous view cannot be obtained [11].…”