Ultrasound-guided evaluation of the lumbar subarachnoid space in lateral and sitting positions in pregnant patients to receive elective cesarean operation

Ucarli Gulay, Turkay Meltem, Sinikoglu Sitki Nadir, Alagol Aysin, Ucarli Gulay, Turkay Meltem, Sinikoglu Sitki Nadir, Alagol Aysin

Abstract

Background and objective: The aim was to compare visibility of the spinal space in sitting and lateral positions, number of attempts, spinal needle depth, skin-dura mater distance and the possible complications; in application of spinal anesthesia, using ultrasound in pregnant patients scheduled to receive elective cesarean operations.

Methods: The study was conducted prospective-randomly after receiving approval from the ethics committee and the patients' permission. ASA I-II 50 pregnant patients were divided into two groups. The patients in Group SP were those placed in a sitting position and the patients in Group LP were those placed in a lateral position. In both groups, the skin-dura mater distance was recorded through an out-of plane technique accompanied by ultrasound. The depth of the spinal needle was measured. The number of attempts, the level of attempts recorded. The degree of visibility of the vertebral space was observed through ultrasound and was numerically scored. Intraoperative and postoperative complications were recorded.

Results: There was no difference between the number of attempts, Modified Bromage Scale and mean measurements of skin-dura mater distance observed through ultrasound. The mean needle depths of Group LP were statistically found significantly higher than Group SP (p=0.002).

Conclusion: Our study supports the notion that access to the skin-dura mater distance is longer in the lateral decubitus position when skin-dura mater distance is evaluated by measuring needle depth.

Keywords: Cesarean Section; Spinal Anesthesia; Ultrasound.

Figures

Fig.1
Fig.1
Ultrasonic image of sonoanatomic structures in intervertebral space and skin-dura mater distance.
Fig.2
Fig.2
Ultrasonic image of the needle point

References

    1. Cooper GM, McClure JH. Maternal deaths from anaesthesia An extract from Why Mothers Die 2000-2002, the Confidential Enquiries into Maternal Deaths in the United Kingdom: Chapter 9: Anaesthesia. Br J Anaesth. 2005;94:417–423. doi: 10.1093/bja/aei066.
    1. Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94:888–906.
    1. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7–17.
    1. Gnaho A, Nguyen V, Villevielle T, Frota M, Marret E, Gentili ME. Assessing the depth of the subarachnoid space by ultrasound. Rev Bras Anestesiol. 2012;62:520–530.
    1. Thakur A, Bhardwaj M, Kaur K, Dureja J, Hooda S, Taxak S. Intrathecal clonidine as an adjuvant to hyperbaric bupivacaine in patients undergoing inguinal herniorrhaphy: A randomized double-blinded study. J Anaesthesiol Clin Pharmacol. 2013;29:66–70. doi: 10.4103/0970-9185.105804.
    1. Arzola C, Balki M, Carvalho JCA. The anterior-posterior diamater of the lumbar dural sac does not predict sensory levels of spinal anesthesia for Cesarian delivery. Can J Anesth. 2007;54:607–612. doi: 10.1007/BF03022955.
    1. Ki JC, Vincent C. Ultrasonography as a preoperatif assessment tool: predicting the feasibility of central neuraxial blockade. Anesth Analg. 2010;110:252–253. doi: 10.1213/ANE.0b013e3181bf9e71.
    1. Kerby B, Rohling R, Nair V, Abolmaesumi P. Automatic identification of lumbar level with ultrasound. Conf Proc IEEE Eng Med Biol Soc. 2008;2008:2980–2983. doi: 10.1109/IEMBS.2008.4649829.
    1. Prasad GA, Tumber PS, Lupu CM. Ultrasound guided spinal anesthesia. Can J Anaesth. 2008;55:716–717. doi: 10.1007/BF03017749.
    1. Furness G, Reilly MP, Kuchi S. An evalution of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002;57(3):277–280.
    1. Watson MJ, Evans S, Thorp JM. Could Ultrasonography be used by an anaesthetist to identify a specified lumbar interspace before spinal anaesthesia. Br J Anaesth. 2003;90:509–511. doi: 10.1093/bja/aeg096.
    1. Whitty R, Moore M, Macarthur A. Identification of the lumbar interspinous spaces: palpation versus ultrasound. Anesth Analg. 2008;106:538–540. doi: 10.1213/ane.0b013e31816069d9.
    1. Schlotterbeck H, Schaeffer R, Dow WA, Touret Y, Bailey S, Diemunsch P. Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia. Br J Anaesth. 2008;100:230–234. doi: 10.1093/bja/aem371.
    1. Locks Gde F, Almeida MC, Pereira AA. Use of the ultrasound to the determine the level of lumbar puncture in pregnant women. Rev Bras Anestesiol. 2010;60:13–19.
    1. Shahzad K, Afshan G. Induction position for spinal anaesthesia: sitting versus lateral position. J Pak Med Assoc. 2013;63:11–15.
    1. Yun EM, Marx GF, Santos AC. The effect of maternal position during induction of combined spinal-epidural anesthesia for cesarian delivery. Anesth Analg. 1998;87:614–618.
    1. Inglis A, Daniel M, Mcgrady E. Maternal position during induction of spinal anestesia for caserian section A comprasion of right lateral and sitting positions. Anaesthesia. 1995;50:363–365.
    1. Balki M, Lee Y, Halpern S, Carvalho JC. Ultrasound imaging of the lumbar spine in the transverse plane: the ccorrelation between estimated and actuel depth to the epidural space in obese parturients. Anaesth Analg. 2009;108:1876–1881. doi: 10.1213/ane.0b013e3181a323f6.
    1. Palmer SK, Abram SE, Maitra AM, Von Colditz JH. Distance from the skin to the lumbar epidural space in an obstetric population. Anesth Analg. 1983;62:944–946.
    1. Bassiakou E, Valsamidis D, Loukeri A, Karathanos A. The distance from the skin to the epidural and subarachnoid spaces in parturients scheduled for caesarian section. Minerva Anestesiol. 2011;77:154–159.
    1. Hamza J, Smida M, Benhamou D, Cohen SE. Parturient’s posture during epidural puncture affects the distance from skin to epidural space. J Clin Anesth. 1995;7:1–4. doi: .
    1. Schnabel A, Schuster F, Ermert T, Eberhart LH, Metterlein T, Kranke P. Ultrasound guidance for neuraxial analgesia and anesthesia in obstetric: a quantative systematic review. Ultraschall Med. 2012;33:132–137. doi: 10.1055/s-0029-1245724.
    1. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169–175. doi: 10.1016/S0952-818.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner