Home⇛The PCMC Journal⇛vol. 15 no. 2 (2019)

The Use of Preprocedure Ultrasound as an Adjunct to Lumbar EpiduralAnesthesia in Parturients: A Randomized Control Trial.

Jose Paulo Z. Aliling | Aida Z. Cristobal

 

Abstract:

BACKGROUND: Conventional epidural anesthesia technique is a blind procedure, which relies solely on the palpation of the landmarks. Pregnancy makes epidural insertion more difficult because of the exaggeration of the lumbar iordosis, increase in subcutaneous fat, and difficulty in positioning due to the gravid uterus. These changes may make the conventional palpation technique less reliable in placing the epidural catheter during labor. Preprocedure ultrasound may be used as an adjunct in facilitating lumbar epidural insertion. OBJECTIVES: The objective of the study was to determine the efficacy of preprocedure ultrasound in facilitating lumbar epidural insertion. This was achieved by determining the number of attempts, number of needle redirections, and incidence of adverse events with and without the use of ultrasound. METHODS: The study was a randomized controlled trial. Forty two (42) subjects were enrolled in the study and were randomized into either the preprocedure ultrasound gorup or the conventional palpation technique group. Efficacy of the technique was measured according to the following variables: number of attempts, number of redirections, incidence of traumatic insertion and incidence of accidental dural puncture. RESULTS: There was a significant difference in the number of attempts (p value of 0.03) and needle redirections (p value of 0.04) between the two (2) groups. There was no significant difference noted in the proportion of subjects with accidental dural puncture and traumatic insertion between the two (2) groups (p=1.00). CONCLUSION: The number of attempts and needle redirections were significantly lower in those with ultrasound use compared to those without. No adverse events were noted on both groups. RECOMMENDATIONS: Future studies may focus on the obese population utilizing larger samples wherein the landmarks needed for epidural placement are extremely difficult to identify. The length of time required to successfully insert the epidural with and without the use of preprocedure ultrasound can also be considered.



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