Abstract
Purpose
Epidural cannulation is a difficult technique in the patient undergoing scoliosis repair, due to axial rotation of the vertebral bodies, as well as angulation of the spinal processes. This case series was performed to investigate whether ultrasonography could facilitate epidural insertion in patients with scoliosis, by assessing the degree of vertebral body rotation.
Clinical features
Eleven patients scheduled for corrective scoliosis surgery were studied. The spine was examined ultrasonically using a portable ultrasound system with a 38-mm linear probe in two-dimensional B mode. The angulation of the probe head (measured using an inclinometer held in alignment with its long axis) at which the echo signals from the laminae became level on the screen was taken to correspond to the degree of vertebral rotation. The least rotated (most neutral) vertebral interspace was located, and a supervised anesthesiology trainee then performed epidural catheter insertion, using a loss-of-resistance technique. Bupivacaine 0.125% with fentanyl 4 μg·mL-1 was infused after surgery, and successful epidural placement was indicated by the presence of effective analgesia and loss of sensation to cold stimuli. In ten patients, the neutral space could be identified, while in one, the least rotated space was measured at 15° from the horizontal. Epidural catheterization was successful in eight of 11 patients at the identified level. In two other patients, the space above was employed. The information was described as helpful in seven patients.
Conclusion
We conclude that ultrasonography may have a potential role to facilitate insertion of epidural catheters in patients with scoliosis.
Résumé
Objectif
La mise en place ďun cathéter péridural est difficile chez le patient qui doit subir la correction chirurgicale ďune scoliose, à cause de la rotation axiale des corps vertébraux et de ľangulation des apophyses rachidiennes. Nous voulions vérifier si ľéchographie pouvait faciliter ľinsertion péridurale dans les cas de scoliose, en évaluant le degré de rotation du corps vertébral.
Éléments cliniques
Onze patients admis pour la correction chirurgicale ďune scoliose ont participé à ľétude. Un examen échographique de la colonne a été fait en mode B bidimensionnel avec un système portable comportant une sonde linéaire de 38 mm. Ľangulation de ľextrémité de la sonde (mesurée avec un inclinomètre aligné avec son axe long), à laquelle les échos provenant de la lame se maintenaient horizontaux à ľécran, est présumée correspondre au degré de rotation vertébrale. Ľespace intervertébral le moins dévié (le plus neutre) a été localisé et, sous supervision, un résident en anesthésiologie a inséré un cathéter péridural selon la technique de perte de résistance. De la bupivacaïne à 0,125 % et 4 μg·mL-1 de fentanyl ont été perfusés après ľopération. Ľefficacité de ľanalgésie et la perte de sensation au froid indiquaient la bonne position du cathéter. Chez dix patients, ľespace neutre a été repéré, mais chez un patient, ľespace le moins dévié était à 15° de ľhorizontal. Le cathétérisme péridural a été réussi chez 8 des 11 patients au niveau identifié. Chez deux autres patients, ľespace audessus a été utilisé. Ľéchographie a été jugée utile chez sept patients.
Conclusion
Ľéchographie peut faciliter ľinsertion ďun cathéter péridural chez des patients atteints de scoliose.
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References
Currie JM. Measurement of the depth to the extradural space using ultrasound. Br J Anaesth 1984; 56: 345–7.
Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia 2002; 57: 277–80.
Watson MJ, Evans S, Thorp JM. Could ultrasonography be used by an anaesthetist to identify a specified lumbar interspace before spinal anaesthesia? Br J Anaesth 2001; 90: 509–11.
Suzuki S, Yamamuro T, Shikata J, Shimizu K, Iida H. Ultrasound measurement of vertebral rotation in idiopathic scoliosis. J Bone Joint Surg 1989; 71-B: 252–5.
Cobb JR. Outline for the study of scoliosis.In: Blount WP, Banks SW (Eds). The American Academy of Orthopaedic Surgeons, Instructional Course Lectures, vol 5. Ann Arbor, MI: JW Edwards; 1948: 261–75.
Nash CL, Moe JH. A study of vertebral rotation. J Bone Joint Surg (Am) 1969; 51-A: 223–9.
Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med 2001; 26: 64–7.
Grau T, Bartusseck E, Conradi R, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anesth 2003; 50: 1047–50.
Hatfield A, Bodenham A. Ultrasound: an emerging role in anaesthesia and intensive care. Br J Anaesth 1999; 83: 789–800.
National Institute for Clinical Excellence. Final Appraisal Determination. Ultrasound locating devices for placing central venous catheters. Available from URL; http://www.nice.org.uk/page.aspx?o=35419.
Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth 2002; 89: 254–9.
Chan VW, Perlas A, Rawson R, Odukoya O. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg 2003; 97: 1514–7.
Scott DH. ‘In the country of the blind, the one-eyed man is king’, Erasmus (1466-1536) (Editorial). Br J Anaesth 1999; 82: 820–1.
Chen CP, Tang SF, Hsu TC, et al. Ultrasound guidance in caudal epidural needle placement. Anesthesiology 2004; 101: 181–4.
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McLeod, A., Roche, A. & Fennelly, M. Case series: ultrasonography may assist epidural insertion in scoliosis patients. Can J Anesth 52, 717–720 (2005). https://doi.org/10.1007/BF03016559
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DOI: https://doi.org/10.1007/BF03016559