Efficacy of ultrasound-guided lumbar epidural access using paramedian transverse scanning with the needle in-plane: a comparison with paramedian saggital scanning

Abstract

Objective To compare the efficacy of ultrasound-guided lumbar epidural access using paramedian transverse scanning(PMTS) versus paramedian saggital scanning (PMSS) with the needle in-plane. Methods Fifty American Society of Anesthesiologists physical statusⅠ-Ⅲ patients, aged 50-75 yr, weighing 55-85 kg, undergoing lower extremity surgery under combined spinal-epidural anesthesia, were divided into PMSS group (n=25) and PMTS group (n=25) using a random number table.The real-time ultrasound-guided lumbar epidural access (L3, 4) was performed using PMTS and PMSS in PMTS and PMSS groups, respectively.The visibility of ligamentum flavum, posterior and anterior dura maters, posterior epidural space on the prepuncture ultrasound images, imaging quality score, time for puncture and depth of puncture were recorded.The development of air ultrasonic contrast sign and backflow of cerebrospinal fluid from the spinal needle were recorded.The development of adverse reactions such as paresthesia and hypokinesia was also recorded on 2 days after operation. Results Compared with group PMSS, the time for puncture was significantly shortened, the depth of puncture was shallower (P 0.05). No significant change was found in adverse reactions such as paresthesia or hypokinesia between the two groups (P>0.05). Conclusion PMTS provides clear imaging and simple and convenient operation in guiding lumbar epidural access with the needle in-plane when compared with PMSS, and it is worthy of clinical application. Key words: Ultrasonography; Epidural space; Subarachnoid space; Punctures