Lumbar Epidural Placement Research Articles

Interdisciplinary development and evaluation of a novel needle guide for ultrasound-guided lumbar epidural placement

PurposeA solution for real-time, ultrasound-guided, central neuraxial blockade placement remains elusive. A device that enables single-operator neuraxial placement while simultaneously visualising the spinal anatomy and needle trajectory may improve patient...

A do-it-yourself 3D-printed thoracic spine model for anesthesia resident simulation.

Central line placement, cricothyroidotomy, and lumbar epidural placement are common procedures for which there are simulators to help trainees learn the procedures. However, a model or a simulator for thoracic epidurals is not commonly used by anesthesia training programs to help teach the procedure. This brief technical report aims to share the design and fabrication process of a low-cost and do-it-yourself (DIY) 3D-printed thoracic spine model. Ten expert anesthesiology attendings and fifteen novice anesthesiology residents practiced with the model and were subsequently surveyed to assess their attitudes towards its fidelity and usefulness as a teaching tool. Responses were recorded with a Likert scale and found to be positive for both groups. Design files and an assembly manual were developed and made public through an open-source website.

Utility of ultrasonography in identification of midline and epidural placement in severely obese parturients.

Due to body habitus, lumbar epidural placement can be challenging in severely obese parturients. Several studies have been published assessing the usefulness of ultrasonography in the placement of neuraxial blocks. One patient population that is under-represented in these studies is the severely obese parturient. We sought to determine if performing an abbreviated ultrasound exam of the lumbar spine to determine midline by locating spinous process could facilitate lumbar epidural placement in severely obese parturients. One hundred fifty patients with a Body Mass Index (BMI) of ≥35 kg/m2 were randomized into two groups. The palpation (P) group had midline identified by the traditional palpation technique. The ultrasonography (U) group had midline identified by ultrasound visualization of the spinous process in the transverse plane. Midline identification and epidural placement were done by both junior and senior anesthesiology residents at our teaching institution. Data were analyzed on all 150 patients. BMI was similar in the U and P groups (43.3 vs. 44.4 kg/m2, P=0.359). Time for epidural placement (6.2 vs. 9.0 minutes, P<0.01) and total procedure time (6.9 vs. 9.5 minutes, P<0.01) were significantly less in the U group. The number of needle passes (2.1 vs. 2.8, P=0.02) was also less in the U group. There was no significant difference in the failure rates of the U and P groups (4.0% vs. 9.3%, P=0.19). The use of an abbreviated ultrasound exam to identify midline in severely obese parturients can reduce the time required for lumbar epidural placement.

Thoracic Epidural Analgesia and Acute Pain Management

AIN continues to be a significant problem for many patients after major surgery. In addition to improving patient satisfaction and decreasing pain scores, enhanced perioperative pain control can improve clinical outcomes. Thoracic epidural analgesia (TEA) remains a critical tool for anesthesiologists to use in acute pain management. TEA is particularly effective for reducing pain after thoracic and upper abdominal surgery and likely permits major surgical procedures to be performed on patients with moderate to severe comorbid diseases, who several years ago may have been determined to be too great a risk for surgery. In the past 10 yr, peripheral nerve blockade has improved perioperative analgesia for patients undergoing extremity surgery. Although nerve blocks have reduced the use of continuous lumbar epidural analgesia, anesthesiologists must understand the indications, placement techniques, solutions administered, potential complications, and evidence-based outcomes for TEA in acute pain management. Indications