title: Eyes in the needle: novel epidural needle with embedded high-frequency ultrasound transducer--epidural access in porcine model.
abstract: BACKGROUND
  Epidural needle insertion is usually a blind technique where the rate of adverse events depends on the experience of the operator. A novel ultrasound method to guide epidural catheter insertion is described.
  
  
  METHODS
  An ultrasound transducer (40 MHz, a -6 dB fractional bandwidth of 50%) was placed into the hollow chamber of an 18-gauge Tuohy needle. The single crystal was polished to a thickness of 50 μm, with a width of 0.5 mm. Tissue planes were identified from the reflected signals in an A-mode display. The device was inserted three times into both the lumbar and thoracic regions of five pigs (average weight, 20 kg) using a paramedian approach at an angle of 35-40°. The epidural space was identified using signals from the ligamentum flavum and dura mater. Epidural catheters were placed with each attempt and placement confirmed by contrast injection.
  
  
  RESULTS
  The ligamentum flavum was identified in 83.3% of insertions and the dura mater in all insertions. The dura mater signal was stronger than that of the ligamentum flavum and served as a landmark in all epidural catheter insertions. Contrast studies confirmed correct placement of the catheter in the epidural space of all study animals.
  
  
  CONCLUSIONS
  This is the first study to introduce a new ultrasound probe embedded in a standard epidural needle. It is anticipated that this technique could reduce failed epidural blocks and complications caused by dural puncture.
authors.affiliation: Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Huihua K
authors.initials: HK
authors.lastname: Chiang
authors.forename: Qifa
authors.initials: Q
authors.lastname: Zhou
authors.forename: M Susan
authors.initials: MS
authors.lastname: Mandell
authors.forename: Mei-Yung
authors.initials: MY
authors.lastname: Tsou
authors.forename: Shih-Pin
authors.initials: SP
authors.lastname: Lin
authors.forename: K Kirk
authors.initials: KK
authors.lastname: Shung
authors.forename: Chien-Kun
authors.initials: CK
authors.lastname: Ting
mesh_terms: D000767:Anesthesia, Epidural / Q000295:instrumentation / Q000379:methods; D000818:Animals; D004388:Dura Mater / Q000000981:diagnostic imaging; D019160:Endosonography / Q000295:instrumentation* / Q000379:methods; D004824:Epidural Space / Q000000981:diagnostic imaging*; D023421:Models, Animal; D009339:Needles; D013552:Swine; D014159:Transducers