Epidural catheter placement in morbidly obese parturients with the use of an epidural depth equation prior to ultrasound visualization

Sukhdip Singh, Keith M Wirth, Amy L Phelps, Manasi H Badve, Tanmay H Shah, Neera Sah, Manuel C Vallejo, Sukhdip Singh, Keith M Wirth, Amy L Phelps, Manasi H Badve, Tanmay H Shah, Neera Sah, Manuel C Vallejo

Abstract

Background: Previously, Balki determined the Pearson correlation coefficient with the use of ultrasound (US) was 0.85 in morbidly obese parturients. We aimed to determine if the use of the epidural depth equation (EDE) in conjunction with US can provide better clinical correlation in estimating the distance from the skin to the epidural space in morbidly obese parturients.

Methods: One hundred sixty morbidly obese (≥40 kg/m(2)) parturients requesting labor epidural analgesia were enrolled. Before epidural catheter placement, EDE was used to estimate depth to the epidural space. This estimation was used to help visualize the epidural space with the transverse and midline longitudinal US views and to measure depth to epidural space. The measured epidural depth was made available to the resident trainee before needle insertion. Actual needle depth (ND) to the epidural space was recorded.

Results: Pearson's correlation coefficients comparing actual (ND) versus US estimated depth to the epidural space in the longitudinal median and transverse planes were 0.905 (95% CI: 0.873 to 0.929) and 0.899 (95% CI: 0.865 to 0.925), respectively.

Conclusion: Use of the epidural depth equation (EDE) in conjunction with the longitudinal and transverse US views results in better clinical correlation than with the use of US alone.

Figures

Figure 1
Figure 1
Epidural depth equation plus longitudinal US view versus clinical needle depth.
Figure 2
Figure 2
Epidural depth equation plus transverse US view versus clinical needle depth.

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