title: Ultrasound control for presumed difficult epidural puncture.
abstract: BACKGROUND
  The efficacy of epidural anaesthesia depends on the accurate identification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to investigate whether pre-puncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia.
  
  
  METHODS
  We used digital ultrasound equipment with a 5-MHz transducer to assess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were scheduled for epidural anaesthesia. The women were randomised into two equal groups. In all patients, the standard loss of resistance technique was used. In the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultrasound images was compared to the ES depth measured by the needle. We compared the number of puncture attempts with the standard method (control group) to the number of attempts under ultrasound guidance.
  
  
  RESULTS
  Ultrasonography significantly improved operating conditions for epidural anaesthesia. The maximum VAS scores and patient acceptance were significantly better.
  
  
  CONCLUSIONS
  With ultrasound measurement of the ES depth, the quality of epidural anaesthesia was enhanced.
authors: Department of Anaesthesiology, University of Heidelberg, Germany. thomas.grau@med.uni-heidelberg.de
authors: T
authors: T
authors: Grau
authors: R W
authors: RW
authors: Leipold
authors: R
authors: R
authors: Conradi
authors: E
authors: E
authors: Martin
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000379:methods*; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D009339:Needles; D010147:Pain Measurement; D011247:Pregnancy; D012867:Skin / Q000000981:diagnostic imaging; D014463:Ultrasonography