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Does Ultrasound-guided CSE (combined spinal epidural) improve midline placement of epidural needle with positive CSF flow through the spinal needle, compared to placement using palpation of anatomical landmarks?
Abstract Number: F-08
Abstract Type: Original Research
Purpose: To determine if Ultrasound guidance leads to increased positive CSF flow on first attempt at combined spinal epidural in parturients compared to anatomical landmark technique.
Methods: We conducted a randomized prospective trial on the Labor and Delivery unit of a busy New York City hospital. All parturients requesting neuraxial labor analgesia, and without obstetric complications or history of lumbar musculoskeletal abnormalities, were eligible for enrollment. A total of 48 patients were consented to receive combined spinal epidural with either ultrasound guided or anatomical landmark technique. Positive CSF on the first attempt was the primary outcome. Secondary outcomes were the number of spaces attempted and number of needle adjustments within the space, as well as presence of symmetrical anesthesia at 2 hours, and need for epidural replacement. The procedure was performed by experienced practitioners consisting of obstetric anesthesiology fellows and attending physicians.
Results: 48 patients were randomized to either the ultrasound or landmark group. 2 patients in the Landmark group were excluded from the study due to delivery within 2 hours of CSE placement. No statistical difference was found between groups for positive CSF flow on first attempt at CSE (p = 0.6). All secondary outcomes were statistically insignificant as well: number of spaces attempted (p=0.71 95% CI -0.30 to 0.21), number of needle adjustments (p = 0.09, 95% CI -0.10 to 1.28), presence of symmetrical anesthesia at 2 hours (p = 1), and need for epidural replacement (p=0.48).
Conclusion: When placed by an experience physician, there is no difference in the successful placement of CSE on the first attempt with ultrasound versus traditional landmark technique.