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Paolo PERNA 1 , Antonio GIOIA 2, Riccardo RAGAZZI 2 , Carlo A. VOLTA 2 , Massimo INNAMORATO 1
1 Department of Anesthesia and Pain Medicine, Ospedale Santa Maria delle Croci, Ravenna, Italy; 2 Department of Anesthesia and Critical Care, University of Ferrara, Arcispedale Sant’Anna, Ferrara, Italy
BACKGROUND: Regional epidural analgesia is considered the gold standard for pain treatment in labour but the epidural catheter placement may be a difficult procedure because of the difficulty in anatomical landmarks palpation. These difficulties increase in pregnant women. Pre-procedure neuroaxial ultrasound may facilitate the procedure.
METHODS: Prospectic randomized controlled study conducted in the Labour Ward. We randomized two groups of women undergoing epidural analgesia: Group A (28 patients), with loss of resistance technique and Group B (30 patients) with US assisted procedure. In both groups we measured the real depth of epidural space measuring the needle skin-to-tip
distance and in Group B only we measured the ultrasound depth.
RESULTS: In Group A the mean number of attempts was 3.43 ± 3.8, significantly higher then Group B where the number of attempts was 1.70 ± 0.87 (p = 0.019). By considering data by Group B it emerges a strong positive correlation between the epidural real depth, RD and ultrasound depth, UD (Pearson coefficient=0.88, p < 0.0001).
CONCLUSIONS: Ultrasound-assisted technique for epidural catheter placement for labor analgesia is safe, effective, easy to perform and valuable aid to improve the identification of epidural space when compared with anatomical landmark and loss of resistance technique. Pre-puncture ultrasound assessment shows the exact intervertebral space, the optimal point of insertion and the tilt angle of the needle, the depth of the epidural space and any anatomical abnormality of the spine, increasing the success rate and reducing the procedure complications of the blind approach.