title: Prediction of the distance from the skin to the lumbar epidural space in the Greek population, using mathematical models.
abstract: OBJECTIVE
  The skin to lumbar epidural space distance (SLED) is variable, and therefore the ability to clinically predict the SLED may help increase the success of epidural anesthesia/analgesia. The goal of this study was to determine the relationship between the SLED and demographic/anthropometric variables in the Greek population, and develop a mathematical model for its prediction.
  
  
  METHODS
  This prospective randomized study enrolled 406 male and female Greek patients who required an epidural block as part of their anesthetic management. With patients placed in the left lateral and knee-chest position, the lumbar epidural space was located by the loss of resistance to normal saline technique. Statistical analysis was used to identify the relationship between SLED, and the following variables were evaluated: age, weight, height, body mass index, body surface area, intervertebral space used, pregnancy, and geographic origin within Greece.
  
  
  RESULTS
  No adverse events or dural punctures occurred. Mean SLED in the general population was 4.98 +/- 0.95 cm, with values significantly higher in males (5.37 +/- 0.88 cm) compared with females (4.83 +/- 0.93 cm). SLED was best associated with weight, body surface area, and body mass index. Mathematical formulae for prediction of SLED in the general population and the female population were derived from linear regression analysis. These formulae were able to predict approximately half of the observed variability in SLED.
  
  
  CONCLUSIONS
  While mathematical models of SLED can be a useful tool, they should not be exclusively relied on in the clinical setting, but rather should be used as an adjunct to standardized techniques to improve the safety and efficacy of epidural anesthesia/analgesia.
authors.affiliation: Anaesthesiology Department, Aretaieion University Hospital, University of Athens, Athens, Greece.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Stamatakis
authors.forename: Eleni
authors.initials: E
authors.lastname: Moka
authors.forename: Ioanna
authors.initials: I
authors.lastname: Siafaka
authors.forename: Erifilli
authors.initials: E
authors.lastname: Argyra
authors.forename: Athina
authors.initials: A
authors.lastname: Vadalouca