Role Of ultrasound In central neuraxial blockade
Standard practice central neuraxial blocks (CNB) commonly performed in sitting position involves using surface landmark technique (identification of Tuffier’s line), operators feeling of tactile sensation and or seeing free flow of cerebrospinal fluid (CSF). Although identification of spinous p...
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| Format: | Book Chapter |
| Language: | English |
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| Online Access: | http://irep.iium.edu.my/87623/7/87623%20Role%20Of%20Ultrasound%20In%20Central%20Neuraxial%20Blockade.pdf http://irep.iium.edu.my/87623/ |
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| Summary: | Standard practice central neuraxial blocks (CNB)
commonly performed in sitting position involves
using surface landmark technique (identification of
Tuffier’s line), operators feeling of tactile sensation
and or seeing free flow of cerebrospinal fluid (CSF).
Although identification of spinous process are very
reliable, surface anatomy landmarks sometimes are
not always easily identified, especially in patients
with spinal deformity, for example kyphoscoliosis,
obesity, oedema or previous back surgery.1,2
Tuffier’s line, a line drawn between the highest point
of iliac crests is widely used as estimation of L3 - L4
interspace, but the correlation is inconsistent.3 The
precision of identification varies and inaccurate in
many patients may end up needle placement one
or two spinal levels higher.1,2,4-7 Surface landmark
technique does not give the anaesthesiologist
reliability to locate the space for needle insertion,
predict ease of needle placement and avoiding
accidental dural puncture during epidural insertion.
Ultrasound imaging can be used to preview the
underlying spinal anatomy (pre-procedural scan)
or guide the spinal needle in real-time during
performing CNB. The ultrasound can 60% correctly
identified L2 - L3 interspace, with margin of error 7
- 9% either one space above or below, in comparison
with clinical assessment 9 - 18% up to 2 spaces
higher or lower (more significant variability).10 With
pre-procedural ultrasound scan, the reliability of
identification of the L3-L4 interspace increases to
almost 70 - 80%. An anaesthesiologist can identify
the midline of the spine accurately, identify the
correct lumbar interspace, measure and predict
skin to space distance and identify patients with
potentially difficult CNB.1,2,8,9,11 |
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