Color Doppler Ultrasound to Locate Needle in Labor Epidural
| Status: | Completed |
|---|---|
| Conditions: | Women's Studies |
| Therapuetic Areas: | Reproductive |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 7/25/2018 |
| Start Date: | May 28, 2018 |
| End Date: | June 30, 2018 |
Use of Color Doppler Ultrasonography to Confirm the Position of a Labor Epidural Needle - a Retrospective Case Series
Color Flow Doppler (CFD) utilizes Doppler information obtained from signals sent to and
received from a transducer. This information is color-encoded and then displayed as color on
an overlay of the two-dimensional image. The color scale represents both speed and direction
of flow within a discrete area of the image. CFD has been recently used to determine the
position of the epidural catheter. However its role in labor epidural has yet to be defined.
This study describes the use of CFD to confirm the position of the tip of the epidural needle
in the context of labor analgesia. This study hypothesized that CFD is a feasible method for
identifying proper epidural needle placement prior to epidural catheter advancement.
received from a transducer. This information is color-encoded and then displayed as color on
an overlay of the two-dimensional image. The color scale represents both speed and direction
of flow within a discrete area of the image. CFD has been recently used to determine the
position of the epidural catheter. However its role in labor epidural has yet to be defined.
This study describes the use of CFD to confirm the position of the tip of the epidural needle
in the context of labor analgesia. This study hypothesized that CFD is a feasible method for
identifying proper epidural needle placement prior to epidural catheter advancement.
After obtaining approval by the Institutional Review Board and a waiver of informed consent,
thirty-five pregnant patients who underwent an ultrasound guided labor epidural between
August of 2017 and June of 2018, were included in this retrospective review. The ultrasound
guided labor epidural was used in those in which an anticipated technical difficulty with
landmark epidural space localization was expected. These included those patients with
diagnosis of obesity and lumbar scoliosis, as well as those with poorly defined surface
lumbar bone anatomy. Patients with history of spine surgery were excluded. Patient data were
obtained from the institutional electronic medical records. Demographic data, intervertebral
level of insertion, dermatome level, and failure rate of epidural needle placement using
color flow Doppler were noted for each patient.
Labor analgesia was obtained via a combined spinal epidural technique. Sterile preparation
and draping of the area was followed by placement of a curvilinear ultrasound transducer in a
sterile sheath. The ultrasound was used to identify the interspinous space. The epidural
needle was guided with the use of real time ultrasound by the use of an out of plane
technique. A two hand technique was used to manipulate the needle and the ultrasound probe. A
17G Tuohy needle (B. Braun Medical Inc, Bethlhem, PA, USA) was advanced until loss of
resistance to normal saline was attained. Confirmation of the epidural space with the use of
color flow Doppler (CFD) was then obtained after injection of up to 10 mL of normal saline
through the epidural needle. A 27G pencil-point spinal needle (B. Braun Medical Inc,
Bethlhem, PA, USA) was then introduced through the epidural needle until cerebro-spinal fluid
(CSF) was obtained. Use of intrathecal fentanyl or local anesthetic plus fentanyl was then
used as a bolus in the spinal space. A 21G epidural catheter (B. Braun Medical Inc, Bethlhem,
PA, USA) was then threaded into the epidural space.
thirty-five pregnant patients who underwent an ultrasound guided labor epidural between
August of 2017 and June of 2018, were included in this retrospective review. The ultrasound
guided labor epidural was used in those in which an anticipated technical difficulty with
landmark epidural space localization was expected. These included those patients with
diagnosis of obesity and lumbar scoliosis, as well as those with poorly defined surface
lumbar bone anatomy. Patients with history of spine surgery were excluded. Patient data were
obtained from the institutional electronic medical records. Demographic data, intervertebral
level of insertion, dermatome level, and failure rate of epidural needle placement using
color flow Doppler were noted for each patient.
Labor analgesia was obtained via a combined spinal epidural technique. Sterile preparation
and draping of the area was followed by placement of a curvilinear ultrasound transducer in a
sterile sheath. The ultrasound was used to identify the interspinous space. The epidural
needle was guided with the use of real time ultrasound by the use of an out of plane
technique. A two hand technique was used to manipulate the needle and the ultrasound probe. A
17G Tuohy needle (B. Braun Medical Inc, Bethlhem, PA, USA) was advanced until loss of
resistance to normal saline was attained. Confirmation of the epidural space with the use of
color flow Doppler (CFD) was then obtained after injection of up to 10 mL of normal saline
through the epidural needle. A 27G pencil-point spinal needle (B. Braun Medical Inc,
Bethlhem, PA, USA) was then introduced through the epidural needle until cerebro-spinal fluid
(CSF) was obtained. Use of intrathecal fentanyl or local anesthetic plus fentanyl was then
used as a bolus in the spinal space. A 21G epidural catheter (B. Braun Medical Inc, Bethlhem,
PA, USA) was then threaded into the epidural space.
Inclusion Criteria:
• Pregnant patients who had labor epidural placed for clinical indications, in whom
ultrasound was used to assist the procedure.
Exclusion Criteria:
- Poor quality ultrasound images judged by experienced anesthesiologist
- Patients with history of lumbar spine surgery
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