Unit:
Κατεύθυνση Περιοχική ΑναισθησίαLibrary of the School of Health Sciences
Author:
Christodoulaki Kalliopi
Supervisors info:
Σιδηροπούλου Τατιανή, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σαραντέας Θεοδόσιος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ματσώτα Παρασκευή, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Υπερηχογραφικά υποβοηθούμενος καθετηριασμός επισκληρίδιου χώρου
Translated title:
Ultrasound assisted catheterization of epidural space
Summary:
Ultrasonography (US) has brought a revolution in anesthetic practice during last years. The use of ultrasound for intravenous line insertion is widely shared, and the ultrasonographic guidance for the performance of peripheral neural blockades is also extensively used. This does not apply to central neuraxial blockades, even though this method is referred in literature since 1980, possibly because of the several limitations of the technique. Although multiple studies and evidence-based guidelines support US for safer and convenient neuraxial blocks, ultrasound-guided neuraxial procedures were not common until recent years.
In the conventional technique, the performance of neuraxial blocks relies primarily on the palpation of anatomical landmarks. This is a blind approach and the variability of patient anatomy may lead to complications occurring during block performance. The anatomic landmarks may be obscured in the case of obesity, oedema or anatomical variation (eg. after surgical operation in spine or presence of scoliosis). Traumatic needle puncture of subarachnoid or epidural space may lead to serious complications (trauma to neuronal structures, epidural haematoma, postdural puncture headache after unintentional dural puncture, paraesthesia). The rate of complications increases after multiple attempts for needle insertion and in the presence of difficult epidural catheterization.
Pre-procedural ultrasound (scanning of the spine prior to neuraxial blockade) can give the anaesthesiologist an opportunity to have an image of the structures of interest with the detection of intervertebral space, the delineation of neuraxial midline, the estimation of the optimal angle for needle insertion and measurement of the depth of the epidural space. This kind of information can increase the success rate on the first attempt, reduce the number of attempts and improves technical and clinical outcomes.
In the present study an analytical description of the ultrasound technique and its clinical use is included, in addition to a review in order to examine the data supporting the use of ultrasound for the assistance of the performance of epidural or subarachnoid block· suggestions for clinical practice are following.
Main subject category:
Health Sciences
Keywords:
Epidural anaesthesia, Subarachnoid anaesthesia, Ultrasound, Spinal column, Central neural blockade
