Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
Department of Surgery, All India Institute of Medical Sciences, Nagpur, Maharashtra, India.
Ann Card Anaesth. 2023 Oct-Dec;26(4):423-430. doi: 10.4103/aca.aca_40_23.
Neuraxial ultrasound (US), a newer modality, can be used for neuraxial imaging, helping in visualizing and aiding in epidural space catheterization. The aim of this study was to evaluate the efficacy of the US for cervical epidural access and to determine the failure rate and complication associated with this technique.
A prospective single-arm pilot study was conducted on 21 participants. The neuraxial US image quality assessment by Ultrasound Visibility Score (UVS), epidural space depth measurement by US and by conventional loss of resistance (LOR) technique, and post-procedure epidural catheter confirmation by real-time US were the study parameters. Any procedural complications or failure rate were recorded. The Kolmogorov-Smirnov test, paired-samples t-test, and Chi-square test were used for the statistical comparison.
The pre-procedural UVS by the transverse interlaminar view (x/21) was 2.81 ± 1.94 and by the oblique paramedian sagittal view was 16.66 ± 2.39 with UVS being best in the paramedian oblique sagittal view (P- value < 0.05). The comparison of depth of the epidural space identified by USG and that by the LOR technique was statistically insignificant (P = 0.83). The average puncture attempts were 1.1 ± 0.3. Post-procedure US epidural catheter confirmation score (x/3) was 1.44 ± 0.44 with either epidural space expansion or microbubbles seen or both.
The pilot study has successfully demonstrated the implication of US for visualizing and aiding in epidural space catheterization. Also, the failure rate and procedural complications were drastically minimized with the help of US as compared to the traditional blind technique.
神经轴超声（US）是一种较新的方法，可用于神经轴成像，帮助可视化并辅助硬膜外空间置管。本研究旨在评估 US 用于颈椎硬膜外入路的效果，并确定与该技术相关的失败率和并发症。
对 21 名参与者进行了前瞻性单臂试点研究。研究参数包括 US 质量评估的超声可视性评分（UVS）、US 和传统的阻力损失（LOR）技术测量的硬膜外空间深度以及实时 US 确认的术后硬膜外导管。记录任何程序并发症或失败率。使用 Kolmogorov-Smirnov 检验、配对样本 t 检验和卡方检验进行统计比较。
横突间矢状视图（x/21）的术前 UVS 为 2.81±1.94，斜旁正中矢状视图为 16.66±2.39，旁正中斜矢状视图的 UVS 最佳（P<0.05）。USG 测量的硬膜外空间深度与 LOR 技术测量的深度无统计学差异（P=0.83）。平均穿刺尝试次数为 1.1±0.3。术后 US 硬膜外导管确认评分（x/3）为 1.44±0.44，可见硬膜外空间扩张或微泡或两者均可见。
该试点研究成功证明了 US 用于可视化和辅助硬膜外空间置管的意义。与传统的盲目技术相比，US 还大大降低了失败率和程序并发症。
