Rivanna Ultrasound for Neuraxial Block
| Status: | Recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 18 - 50 |
| Updated: | 6/17/2018 |
| Start Date: | October 23, 2017 |
| End Date: | September 1, 2019 |
| Contact: | Peter Pan, MD, MSEE |
| Email: | ppan@wakehealth.edu |
| Phone: | 336-718-8278 |
Evaluation of Success in Neuraxial Block Placement Between Using Palpation of Landmark Versus Pocket-Size Handheld Ultrasound (U/S) Method
We hypothesize that the Rivanna Accuro or similar U/S device would reduce time to success of
identifying epidural and/or intrathecal spaces as compared to conventional palpation method.
identifying epidural and/or intrathecal spaces as compared to conventional palpation method.
Administration of (neuraxial blocks) spinal and epidural blocks is commonly achieved by first
palpating the landmarks for midline with spinous process and iliac crest for L3-4-5
intervertebral spaces. With an epidural block, a loss of resistance in a pressurized syringe
is used to incrementally advance the epidural needle until identification of epidural space
with loss of resistance in the pressurized syringe. With a spinal block, the spinal needle is
advanced incrementally until a noted "feel" of dural puncture together with return of spinal
fluid via the spinal needle. The palpation technique and somewhat "blind" technique to
identify the spinal and epidural spaces become more difficult and less reliable particularly
with the increasing prevalence of the morbid and super-morbid obese patients. Ultrasound
devices have become common and successful with non-neuraxial blocks and venous accesses, both
involving mostly non-bony, soft tissues. Application of conventional ultrasound for neuraxial
blocks has been limited by its bulkiness, limited imaging for bony structures and lack of
automated artificial intelligent algorithm for pattern recognition. Recent technological
advancement has addressed the aforementioned limitations. Rivanna Accuro is one such device
that has gained FDA approval and may have helped in addressing some of these issues. It is a
handheld (pocket size) U/S device with real time pattern recognition for bony structures such
as the spine while providing 3-D overlay for recognition of the midline spinous process and
epidural spaces and distance. The investigators hypothesize that the Rivanna Accuro or
similar U/S device would reduce time to success of identifying epidural and/or intrathecal
spaces as compared to conventional palpation method.
palpating the landmarks for midline with spinous process and iliac crest for L3-4-5
intervertebral spaces. With an epidural block, a loss of resistance in a pressurized syringe
is used to incrementally advance the epidural needle until identification of epidural space
with loss of resistance in the pressurized syringe. With a spinal block, the spinal needle is
advanced incrementally until a noted "feel" of dural puncture together with return of spinal
fluid via the spinal needle. The palpation technique and somewhat "blind" technique to
identify the spinal and epidural spaces become more difficult and less reliable particularly
with the increasing prevalence of the morbid and super-morbid obese patients. Ultrasound
devices have become common and successful with non-neuraxial blocks and venous accesses, both
involving mostly non-bony, soft tissues. Application of conventional ultrasound for neuraxial
blocks has been limited by its bulkiness, limited imaging for bony structures and lack of
automated artificial intelligent algorithm for pattern recognition. Recent technological
advancement has addressed the aforementioned limitations. Rivanna Accuro is one such device
that has gained FDA approval and may have helped in addressing some of these issues. It is a
handheld (pocket size) U/S device with real time pattern recognition for bony structures such
as the spine while providing 3-D overlay for recognition of the midline spinous process and
epidural spaces and distance. The investigators hypothesize that the Rivanna Accuro or
similar U/S device would reduce time to success of identifying epidural and/or intrathecal
spaces as compared to conventional palpation method.
Inclusion Criteria:
- BMI >30
- Female requesting analgesia for delivery, be it via vaginal or cesarean delivery
Exclusion Criteria:
- Allergy to ultrasound gel
- Contraindication to receiving neuraxial analgesia
- Under the age of 18
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