Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique

Hesham Elsharkawy, Wael Saasouh, Rovnat Babazade, Loran Mounir Soliman, Jean Louis Horn, Sherif Zaky

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objective: The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design: Prospective descriptive trial on a novel approach. Setting: Operating room and preoperative holding area at a tertiary care hospital. Subjects: Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods: Consented adult patients aged 30-80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2-5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results: Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions: We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

Original languageEnglish (US)
Pages (from-to)1750-1755
Number of pages6
JournalPain Medicine (United States)
Volume20
Issue number9
DOIs
StatePublished - Sep 1 2019

Keywords

  • Anesthesia
  • Epidural
  • Ultrasound Imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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