Ultrasound guided epidural placement in a patient with spinal hardware.
Abstract Number: 175
Abstract Type: Case Report/Case Series
The use of ultrasonography (US) in regional anesthesia has proven to be valuable in both efficiency and accuracy. More recently, the use of US has been applied to neuraxial anesthesia/analgesia in the obstetric population with encouraging results. It has been demonstrated to be accurate, to decrease the number of attempts at placing labor epidural catheters and to assist in the teaching of obstetric anesthesia/analgesia.
Pts with previous spinal surgery (ss) and instrumentation (inst) can create technical challenges to placement of epidural catheters or spinal anesthesia. Often times in these patients it is difficult to identify an applicable interspace (isp) by palpation alone. There have been only a few reports in the literature where the use of US was found valuable in the performance of neuraxial anesthesia/analgesia in parturients with previous ss. We report a case where US allowed quick identification of an applicable isp for epidural analgesia in a parturient who was in rapid labor and gave a history of prior ss with inst.
A 41 yo female G1 presented late in the evening in active labor requesting epidural analgesia. She gave a history of having had ss and inst from L2-S1 (see fig.). PE revealed a term pg female, in active labor with a labor pain score of 10/10. Her spine exam revealed a surgical scar extending from about L2 to S1, consistent with her history. Palpation of the spine revealed no clearly palpable spinous processes along the surgical scar. US of the spine was therefore performed with a 5 MgHz curvilinear probe attached to a Sonosite Turbo-MTM US System. A clearly identifiable isp was seen via ultrasound at the L1-2 level. At this isp a well functioning epidural catheter was successfully placed with a single attempt.
US can give an accurate reading of the depth of the epidural space and assist in identifying the optimal isp to use, and may decrease the complication rate. Previous case studies have suggested that US imaging can facilitate epidural placement in the presence of prior ss. Similarly, US was helpful in our case where we were able to quickly identify an approachable isp and successfully place an epidural catheter with a single attempt. This case demonstrates that US can be a potentially useful additional tool for pts with prior ss.
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