SPINAL ULTRASOUND ASSESSMENT PERFORMED BY TRAINEES DOES NOT IMPROVE
Abstract Number: 163
Abstract Type: Original Research
Introduction: Spinal ultrasound (US) assessment has been shown to improve epidural catheter insertion in patients with both normal and presumed difficult anatomy (1, 2). In previous studies, the same experienced sonographer assessed and marked the spinal landmarks. The impact of teaching US-guided epidural anesthesia on the technical performance of trainees is unknown. This study was conducted to investigate this question.
Methods: With REB approval and informed consent, we recruited anesthesia fellows and second-year residents into the study. Before starting data collection, all trainees were educated with reading material (3) and a 45-minute lecture, followed by one-on-one supervision during 20 US-guided epidurals. Upon completing the teaching steps, the subjects were randomly assigned to perform epidural catheter insertions in laboring women with “easy” spines, either in the traditional fashion (Control Group), or with US guidance (US Group). The primary outcomes were the total procedural time (scanning time, when applicable, plus epidural insertion time from freezing of the skin to epidural needle withdrawal), and the number of ventral passes of the epidural needle.
Results: The total procedural time was significantly longer in the US Group. Epidural catheter insertion time tended to be shorter in the US Group, but this difference was not significant. There were no significant differences in the performance measures (needle ventral passes, attempted intervertebral levels, catheter threading attempts, calls for help, unintentional dural punctures, and catheter re-insertions) between the groups. Patients in the US Group perceived more discomfort than those in the Control Group, but patient satisfaction was otherwise comparable.
Discussion: This is the first study in which a group of trainees was taught spinal ultrasound and actually used the skill while performing epidural anesthesia. The use of ultrasound increased the duration of the procedure and patient discomfort, and was not associated with better outcomes. This study was conducted in the context of easily palpable and aligned spines, so it remains unknown whether this resource would be advantageous in patients with difficult spines.
References: 1) J Clin Anesth 2002;14:169-75; 2) Acta Anaesthesiol Scand 2001; 45:766-71; 3) Anesthesiol Clin 2008; 26:145-58.