Ultrasonography of the Adult Thoracic and Lumbar Spine for Central Neuraxial Blockade

Abstract

The role of ultrasound in central neuraxial blockade has been underappreciated, partly because of the relative efficacy of the landmark-guided technique and partly because of the perceived difficulty in imaging through the narrow acoustic windows produced by the bony framework of the spine. However, this also is the basis for the utility of ultrasound: an interlaminar window that permits passage of sound waves into the vertebral canal also will permit passage of a needle. In addition, ultrasound aids in identification of intervertebral levels, estimation of the depth to epidural and intrathecal spaces, and location of important landmarks, including the midline and interlaminar spaces. This can facilitate neuraxial blockade, particularly in patients with difficult surface anatomic landmarks. In this review article, the authors summarize the current literature, describe the key ultrasonographic views, and propose a systematic approach to ultrasound imaging for the performance of spinal and epidural anesthesia in the adult patient.

Assessment of the spine with CT and MRI prior to interspinous/interlaminar spinal procedures: a pictorial review

“…This is one area where the role of ultrasound should be explored. Ultrasound can be performed in the in vivo situation [11] to confirm prior imaging findings, in addition to its known role in guiding needle access.…”

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

“…To date, this has been only demonstrated in case series and case reports [17,21,42]. Its use may be limited by the requirement for wide bore needles and the technical difficulties associated with simultaneous US scanning and needle advancement [23]. Studies comparing real-time with preprocedure scanning are needed to confirm the utility of this technique.…”

“…Since then multiple case studies and case series have been published on real time needle guidance in performing neuraxial blocks [17,18]. Recently the use of GPS guidance for spinal needle placement was studied by Brinkman et al in human cadavers and attracted much research in this area [19][20][21][22][23][24][25][26][27].…”

Pain Control in Thoracic Surgery

“…Ayrıca, epidural alana midtorasik bölgeden paramediyan yaklaşımın tercih edilmesi uygulamanın başarı oranını arttırır (5). Diğer rejyonal blok tiplerinde gösterilmiş olmasına karşın, ultrasonografi rehberliğinin torakal epidural kateter yerleştirilmesinde yararlı olduğu henüz kanıtlanma-mıştır (17). Lomber ve torakal sufentanil ile torakal sufentanil+bupivakainin post-torakotomi analjezisinde kıyaslandığı çift kör bir çalışmada, epidural alandan serebrospinal sıvıya opioidin geçişini, lokal anesteziklerin kolaylaştırdığı gösterilmiştir (18).…”