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Feasibility of 2-dimensional ultrasound-guided, real-time, single-operator, midline lumbar epidural placement using a novel needle guide.
Abstract Number: T4A-6
Abstract Type: Original Research
Real-time ultrasound-guided (USG) epidural placement has been described using a 2-operator approach; one operator advances the epidural needle with loss of resistance (LOR), the other stabilizes the US probe. (1) A novel needle guide "EpiGuide" (EG) allows the US probe and epidural needle to be held in one hand with the other hand free to perform LOR (Fig 1A). We aimed to determine the feasibility of using 2D US with EG to perform single-operator, real-time, lumbar epidural placement.
With ethics approval and informed consent, 21 volunteers were positioned in left lateral decubitus. First, US determined the L3-4 interspace. At this level, a feasible site for needle insertion was determined by MP and marked (Fig 1B, X). Next, the upper and lower boundaries of the interspace were palpated and marked with a line (Fig 1B, i-line). Finally, with the US probe and EG, the anterior complex was visualized; with a pen instead of a needle the ideal USG needle insertion site was marked (Fig 1B, Y). All marks were transferred to a transparency; mean distance between MP and EG (X and Y) were calculated. 2D US with EG for real-time epidural placement was deemed feasible if the EG mark (Y) fell along i-line (primary outcome).
The EG marks (Y) all fell lateral from the i-line in any subject; feasibility endpoint was not met. The mean (SD) distance between MP to EG (X to Y) was 8.5mm (3.4) in the caudal direction. The mean (SD) distance between the lower margin of the i-line and EG (Y) was 5.0mm (2.5).
Our results suggest that using midline 2D US with EG to perform single-operator real-time lumbar epidural placement results in a systematic lateral offset from midline. The face of the US probe occupies most of the available interspace, and the needle path is obstructed by the L4 spinous process (Fig 1C). This is the first study to explore the use of midline 2D US with a needle guide for real-time epidural placement. The next step should explore placing the US probe with EG in in a paramedian position to facilitate midline needle entry (Fig 1D).
1. H. Elsharkawy et al. JACP 2017