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Utility of Ultrasound in Identification of Midline and Placement of Epidurals in Severely Obese Parturients: A Randomized, Prospective Study
Abstract Number: S5A-5
Abstract Type: Original Research
Introduction: The use of ultrasound for facilitation of labor epidural placement is increasing. There are several studies reporting the use of ultrasound in neuraxial anesthesia, but none looking exclusively at its use in the obese population. The primary aim of this study is to compare the traditional palpation technique to ultrasound in patients with a BMI≥35 kg/m2 to determine the time required to place an epidural catheter. Secondary aims include determining the number of needle passes (or attempts) and the failure rate of both groups. We hypothesize that the use of ultrasound in epidural placement for patients with a BMI≥35kg/m2 will be significantly faster than that of the traditional palpation group.
Methods: This study was approved by the IRB, and all patients gave informed, written consent. Currently, 100 out of 150 patients have been enrolled. Parturients requesting a labor epidural with a BMI≥35kg/m2 were eligible for the study. Exclusion criteria were BMI <35, coagulopathy, platelets <80,000, prior spine surgery or instrumentation, diagnosis of scoliosis, or intracranial or spinal mass. Patients were randomized into the palpation or ultrasound groups. Data collected included: experience level of anesthesia provider (junior or senior resident), time to locate midline, time for epidural placement, number of needle passes, and failure of the epidural. The epidural was placed in standard fashion after identification of midline.
Results: After controlling for provider experience, there was no significant difference between the two methods in time required to place the epidural(p = 0.18), number of needle passes(p = 0.44), number of topoffs required(p = 0.23), or epidural failure rate(p = 0.15). There was a significant difference between the two methods in time required to locate the midline(p < 0.01), with the palpation method being on average 13.5 seconds faster than ultrasound. Significant differences between provider experience levels were found for time to place the epidurals(p<0.01)
Conclusions: Although it is our belief that ultrasound is useful in certain patients and for residents in training, it is unclear at this point whether the use of ultrasound is beneficial in obese patients. Our study did not show a significant difference in time to placement, number of needle passes, or epidural failure rates at this point. Our study represents an interim analysis of our data.