Ultrasound control for presumed difficult epidural puncture

Background: The efficacy of epidural anaesthesia depends on the accurate id entification of the epidural space (ES). Abnormal anatomical conditions may make the procedure difficult or impossible. The aim of this study was to i nvestigate whether prepuncture ultrasound examination of the spinal anatomy might be beneficial in expected cases of difficult epidural anaesthesia. Methods: We used digital ultrasound equipment with a 5-MHz transducer to as sess the anatomy of the ES and the posterior parts of the spinal column. We examined 72 parturients with abnormal anatomical conditions who were sched uled for epidural anaesthesia. The women were randomised into two equal gro ups. In all patients, the standard loss of resistance technique was used. I n the ultrasound group, an ultrasound examination of the appropriate spinal region was conducted prior to epidural puncture. ES depth seen on the ultr asound images was com-pared to the ES depth measured by the needle. We comp ared the number of puncture attempts with the standard method (control grou p) to the number of attempts under ultrasound guidance. Results: Ultrasonography significantly improved operating conditions for ep idural anaesthesia. The maximum VAS scores and patient acceptance were sign ificantly better. Conclusions: With ultrasound measurement of the ES depth, the quality of ep idural anaesthesia was enhanced.