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Comparison of ultrasound measured posterior longitudinal ligament length in parturients in the standard sitting and crossed leg positions: A Case Series
Abstract Number: T-43
Abstract Type: Original Research
Introduction: Neuraxial anesthesia is routinely used in parturients for labor analgesia and cesarean delivery. Ultrasound (US) facilitates the performance of neuraxial blocks1. US has demonstrated the effect of patient position on the visualized length of posterior longitudinal ligament (PLL) 2,3. Improved visualization of the PLL suggests an ‘open acoustic window’, or unobstructed path to the dura between the laminae of the lumbar spine 4.In our experience, having parturients sit in crossed leg position (CLP) compared to standard sitting position (SP) facilitates placement of spinals and epidurals. There are no prospective studies evaluating the role of CLP for neuraxial anesthesia in parturients. We conducted a case series in term pregnant patients to compare the length of PLL, ligamentum flavum (LF) and interlaminar distance (ILD) visualized using US longitudinal paramedian view in CLP and SP. Methods: Five healthy term gestation patients gave written informed consent to participate. In the CLP, patients sat on the bed with their legs crossed, neck and back flexed. In the SP, patients sat on the bed with their feet supported by a chair, neck and back flexed. US was performed in both positions sequentially to measure the best visualized length of PLL, LF and ILD at L3-4 level in longitudinal paramedian view by Investigator 1. Measurements were recorded by Investigator 2 using intrinsic caliper software. Investigator 1 was not informed of the measurements. The patient’s comfort score was also noted in both positions. Results: Mean±SD measurements in cm (SP, CLP) - PLL (0.94±0.3, 1.37±0.6), LF (0.9±0.2, 1.1±0.4) and ILD (2.8±0.6, 3.2±0.5). Details provided in table 1. Conclusion: This series demonstrated the feasibility of using ultrasonography to visualize PLL, LF, and ILD at L3-4 intervertebral space using longitudinal paramedian view in term pregnant women in both CLP and SP. Measurements were found to be longer in CLP which may suggest improved lumbar neuraxial access. All women were comfortable in both positions.
1. Grau T et al. J Clin Anaesth (2002): 14:169-175.
2. Ramsay N et al Br J Anaesth. 2014 Mar; 112(3):556-62.
3. Jones AR et al Anesthesia, 2013 Jan; 68(1):27-30.
4. Weed J et al. Anaesthesia, 2011, 66: 925–930.