Ultrasound Imaging Facilitates Spinal Anesthesia in Adults with Difficult Surface Anatomic Landmarks

Abstract

Preprocedural ultrasound imaging facilitates the performance of spinal anesthesia in the nonobstetric patient population with difficult anatomic landmarks.

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models

“…This localization process may be problematic when patients are obese, pregnant, or have spinal abnormalities, including misalignment or degenerative changes [3][4][5][6][7]. Ultrasound can be used to gain a more accurate understanding of a patient's spinal anatomy, leading to fewer needle insertion attempts and spinal needle manipulations, and improve patient satisfaction [3,5,6,[8][9][10][11][12][13][14][15][16][17][18]. Further, a decrease in the number of needle insertion attempts has been shown to correlate with a decreased incidence of postdural puncture headache [19], new-onset persistent low-back pain [20], and puncture site bleeding [21].…”

“…Seizures or cardiac arrest may result from delivery of anesthetic agents into an inappropriate anatomical space or vasculature [22]. Although additional time is required to establish landmarks using ultrasound guidance, fewer needle insertion attempts are required for successful anesthetic placement [5,21].…”

Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed difficult puncture: A randomized controlled trial

“…Nevertheless, some studies have assessed the comfort of the patient as a secondary outcome. Chin et al did not find that US improved the comfort of the patients during epidural anesthesia before a prosthesis surgery [19]. On the opposite, Grau et al showed in two studies that patient satisfaction was better with than without US [20,24].…”

“…However, in patients with easily palpable anatomical landmarks, the use of pre-procedural spinal ultrasound did not improve the ease of insertion of labour epidural catheters as compared with the traditional palpation technique [28]. Finally, in 120 orthopedic patients undergoing lower limb surgery, US was associated with both a significantly higher number of successful epidural puncture on the first needle insertion attempt (65% vs. 32%) and a significantly smaller number of needle passes (6 [1][2][3][4][5][6][7][8][9][10] vs. 13 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]) [19]. In our study, number of redirections and number of injections performed in a single attempt were not different between the two groups, which probably explain why we did not find any difference in VAS pain.…”

“…Inclusion criteria used to define a presumed difficult puncture were BMI (Body Mass Index) > 30 kg/m 2 , age > 60 years or lumbar scoliosis (Cobb angle > 10 • ) [19,20]. Patients with a history of spinal surgery or spinal malformation like spina bifida, pregnant women, patients taking anti-platelet drugs and those participating in another study were excluded.…”