Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period

Denise Wilkes, Caroline Martinello, Felipe A. Medeiros, Rovnat Babazade, Erin Hurwitz, Naveed Khanjee, Prashanth S. Iyer, Paul Leary, Rakesh B. Va Dhera

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

BACKGROUND: Women have blamed epidurals for their post-partum back pain for decades. Survey-based studies have shown similar incidence of chronic back pain between women who delivered with epidurals compared to those who did not. However, epidural insertion site pain has yet to be evaluated by a quantitative measure: pressure pain threshold (PPT). Algometer measured PPT has been shown to be accurate and reproducible in acute, chronic, and postoperative pain studies. This study determines the effect of ultrasound-based landmarks on the PPT at the epidural insertion site in the post-partum period. METHODS: Participants were randomized into either the ultrasound or sham groups. In addition, a non-randomized control group (no epidural) participated. Ultrasound of the lumbar region was used to mark mid intervertebral levels in the US group but not in the sham group. Epidural were placed using the marks in the US group or palpated bony landmarks in the sham group. PPT at each intervertebral space measured before and after the use of epidural. RESULTS: Epidural placement did significantly decreased PPT in US (68%) and US sham (79%) groups and less in the control group (21%). US group showed decreased PPT only at insertion site whereas US sham group also showed decreased PPT at insertion site and adjacent levels. CONCLUSIONS: We showed that epidural placed with ultrasound-determined landmarks not only improves the success of epidural placement but also minimizes the number of intervertebral levels with decreased PPT.

Original languageEnglish (US)
Pages (from-to)1034-1041
Number of pages8
JournalMinerva Anestesiologica
Volume83
Issue number10
DOIs
StatePublished - Oct 1 2017

Fingerprint

Pain Threshold
Pressure
Pain
Back Pain
Chronic Pain
Lumbosacral Region
Control Groups
Acute Pain
Postoperative Pain
Incidence

Keywords

  • Analgesia epodural
  • Pain
  • Ultrasonography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period. / Wilkes, Denise; Martinello, Caroline; Medeiros, Felipe A.; Babazade, Rovnat; Hurwitz, Erin; Khanjee, Naveed; Iyer, Prashanth S.; Leary, Paul; Va Dhera, Rakesh B.

In: Minerva Anestesiologica, Vol. 83, No. 10, 01.10.2017, p. 1034-1041.

Research output: Contribution to journalArticle

Wilkes, Denise ; Martinello, Caroline ; Medeiros, Felipe A. ; Babazade, Rovnat ; Hurwitz, Erin ; Khanjee, Naveed ; Iyer, Prashanth S. ; Leary, Paul ; Va Dhera, Rakesh B. / Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period. In: Minerva Anestesiologica. 2017 ; Vol. 83, No. 10. pp. 1034-1041.
@article{4d9206059aa04c4286442f9e9cfa486e,
title = "Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period",
abstract = "BACKGROUND: Women have blamed epidurals for their post-partum back pain for decades. Survey-based studies have shown similar incidence of chronic back pain between women who delivered with epidurals compared to those who did not. However, epidural insertion site pain has yet to be evaluated by a quantitative measure: pressure pain threshold (PPT). Algometer measured PPT has been shown to be accurate and reproducible in acute, chronic, and postoperative pain studies. This study determines the effect of ultrasound-based landmarks on the PPT at the epidural insertion site in the post-partum period. METHODS: Participants were randomized into either the ultrasound or sham groups. In addition, a non-randomized control group (no epidural) participated. Ultrasound of the lumbar region was used to mark mid intervertebral levels in the US group but not in the sham group. Epidural were placed using the marks in the US group or palpated bony landmarks in the sham group. PPT at each intervertebral space measured before and after the use of epidural. RESULTS: Epidural placement did significantly decreased PPT in US (68{\%}) and US sham (79{\%}) groups and less in the control group (21{\%}). US group showed decreased PPT only at insertion site whereas US sham group also showed decreased PPT at insertion site and adjacent levels. CONCLUSIONS: We showed that epidural placed with ultrasound-determined landmarks not only improves the success of epidural placement but also minimizes the number of intervertebral levels with decreased PPT.",
keywords = "Analgesia epodural, Pain, Ultrasonography",
author = "Denise Wilkes and Caroline Martinello and Medeiros, {Felipe A.} and Rovnat Babazade and Erin Hurwitz and Naveed Khanjee and Iyer, {Prashanth S.} and Paul Leary and {Va Dhera}, {Rakesh B.}",
year = "2017",
month = "10",
day = "1",
doi = "10.23736/S0375-9393.17.11782-7",
language = "English (US)",
volume = "83",
pages = "1034--1041",
journal = "Minerva Anestesiologica",
issn = "0375-9393",
publisher = "Edizioni Minerva Medica S.p.A.",
number = "10",

}

TY - JOUR

T1 - Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period

AU - Wilkes, Denise

AU - Martinello, Caroline

AU - Medeiros, Felipe A.

AU - Babazade, Rovnat

AU - Hurwitz, Erin

AU - Khanjee, Naveed

AU - Iyer, Prashanth S.

AU - Leary, Paul

AU - Va Dhera, Rakesh B.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - BACKGROUND: Women have blamed epidurals for their post-partum back pain for decades. Survey-based studies have shown similar incidence of chronic back pain between women who delivered with epidurals compared to those who did not. However, epidural insertion site pain has yet to be evaluated by a quantitative measure: pressure pain threshold (PPT). Algometer measured PPT has been shown to be accurate and reproducible in acute, chronic, and postoperative pain studies. This study determines the effect of ultrasound-based landmarks on the PPT at the epidural insertion site in the post-partum period. METHODS: Participants were randomized into either the ultrasound or sham groups. In addition, a non-randomized control group (no epidural) participated. Ultrasound of the lumbar region was used to mark mid intervertebral levels in the US group but not in the sham group. Epidural were placed using the marks in the US group or palpated bony landmarks in the sham group. PPT at each intervertebral space measured before and after the use of epidural. RESULTS: Epidural placement did significantly decreased PPT in US (68%) and US sham (79%) groups and less in the control group (21%). US group showed decreased PPT only at insertion site whereas US sham group also showed decreased PPT at insertion site and adjacent levels. CONCLUSIONS: We showed that epidural placed with ultrasound-determined landmarks not only improves the success of epidural placement but also minimizes the number of intervertebral levels with decreased PPT.

AB - BACKGROUND: Women have blamed epidurals for their post-partum back pain for decades. Survey-based studies have shown similar incidence of chronic back pain between women who delivered with epidurals compared to those who did not. However, epidural insertion site pain has yet to be evaluated by a quantitative measure: pressure pain threshold (PPT). Algometer measured PPT has been shown to be accurate and reproducible in acute, chronic, and postoperative pain studies. This study determines the effect of ultrasound-based landmarks on the PPT at the epidural insertion site in the post-partum period. METHODS: Participants were randomized into either the ultrasound or sham groups. In addition, a non-randomized control group (no epidural) participated. Ultrasound of the lumbar region was used to mark mid intervertebral levels in the US group but not in the sham group. Epidural were placed using the marks in the US group or palpated bony landmarks in the sham group. PPT at each intervertebral space measured before and after the use of epidural. RESULTS: Epidural placement did significantly decreased PPT in US (68%) and US sham (79%) groups and less in the control group (21%). US group showed decreased PPT only at insertion site whereas US sham group also showed decreased PPT at insertion site and adjacent levels. CONCLUSIONS: We showed that epidural placed with ultrasound-determined landmarks not only improves the success of epidural placement but also minimizes the number of intervertebral levels with decreased PPT.

KW - Analgesia epodural

KW - Pain

KW - Ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=85032445818&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032445818&partnerID=8YFLogxK

U2 - 10.23736/S0375-9393.17.11782-7

DO - 10.23736/S0375-9393.17.11782-7

M3 - Article

VL - 83

SP - 1034

EP - 1041

JO - Minerva Anestesiologica

JF - Minerva Anestesiologica

SN - 0375-9393

IS - 10

ER -