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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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Main Author: Abdul Ghani, Muhamad Rasydan
Format: Book Chapter
Language:English
Subjects:
RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
RZ Other systems of medicine
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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spelling my.iium.irep.876232021-01-27T09:22:48Z http://irep.iium.edu.my/87623/ Role Of ultrasound In central neuraxial blockade Abdul Ghani, Muhamad Rasydan RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid RZ Other systems of medicine 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 Book Chapter NonPeerReviewed application/pdf en http://irep.iium.edu.my/87623/7/87623%20Role%20Of%20Ultrasound%20In%20Central%20Neuraxial%20Blockade.pdf Abdul Ghani, Muhamad Rasydan Role Of ultrasound In central neuraxial blockade. In: UNSPECIFIED UNSPECIFIED.
institution Universiti Islam Antarabangsa Malaysia
building IIUM Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider International Islamic University Malaysia
content_source IIUM Repository (IREP)
url_provider http://irep.iium.edu.my/
language English
topic RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
RZ Other systems of medicine
spellingShingle RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
RZ Other systems of medicine
Abdul Ghani, Muhamad Rasydan
Role Of ultrasound In central neuraxial blockade
description 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
format Book Chapter
author Abdul Ghani, Muhamad Rasydan
author_facet Abdul Ghani, Muhamad Rasydan
author_sort Abdul Ghani, Muhamad Rasydan
title Role Of ultrasound In central neuraxial blockade
title_short Role Of ultrasound In central neuraxial blockade
title_full Role Of ultrasound In central neuraxial blockade
title_fullStr Role Of ultrasound In central neuraxial blockade
title_full_unstemmed Role Of ultrasound In central neuraxial blockade
title_sort role of ultrasound in central neuraxial blockade
url http://irep.iium.edu.my/87623/7/87623%20Role%20Of%20Ultrasound%20In%20Central%20Neuraxial%20Blockade.pdf
http://irep.iium.edu.my/87623/
_version_ 1690370758262390784
score 13.211869

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