Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

The primary aim of our research is to evaluate proficiency as measured by the number of needle attempts and redirections after pre-procedural spine sonography. A couple of recent meta-analysis have shown that there is now sufficient evidence to confirm that the use of pre-procedure ultrasound increases epidural catheter placement efficiency by decreasing the number of needle attempts and redirections. Besides, its use may improve patient satisfaction.

The acceptance and increased availability of ultrasound devices is one. Besides, the advent of handheld devices and automated devices may increase portability and ease of identification of spine sonographic landmarks. Our team is now focused in evaluating if they use a portable and automated device could aid with epidural catheter placement when inexperienced operators use the ultrasound.

To begin, select a two to five megahertz curvilinear for the traditional ultrasound device. Set the scanning depth to eight centimeters. Ask the patient to sit in the traditional sitting position, ensuring shoulders are relaxed, chin is to chest, arms are resting on thighs, and the posture is slouched.

Apply ultrasound gel to the transducer. For the longitudinal paramedian view, place the ultrasound probe angled towards the midline over the sacral area, approximately three centimeters from the midline. Move the probe cephalad until a solid hyperechoic line is visualized.

Continue to scan the cephalad until the saw sign appears. For the transverse view, place the ultrasound probe at the predicted midline. Scan the cephalad or caudal region until a long hypoechoic line is noted.

Continue scanning in the cephalad or caudal direction until the desired pattern is localized. Select a cardiac probe and start the marking. Scan the cephalad region as demonstrated.

Once the posterior complex is located, select the caliper on the traditional ultrasound device and adjust the measurement from the skin to the posterior complex. Draw a straight line from the skin to the posterior complex. Then, mark the back marking clip.

For BU users, click on Freeze Image, then click on Actions followed by Line and Measure. For automated device users, place the device on the patient's back and allow it to automatically provide the estimated depth.