Does Ultrasound of the Spine Improve Labor Epidurals/Spinal Anesthesia in Obstetric Patients?
Study Details
Study Description
Brief Summary
The investigators are interested in determining the utility of ultrasound of the spine for labor epidurals or spinal anesthesia for women in labor or having a cesarean delivery. The investigators hypothesized that in women with poor spinal landmarks that the use of ultrasound of the spine will improve the process of placing labor epidurals or spinal anesthetics
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
Ultrasound has been in use for peripheral regional anesthesia for several years and is becoming more common. It is currently routinely used here at the University of Missouri. Ultrasound for neuraxial anesthesia, however, is less common and is only being done in a few centers.. There have been several case reports of its use in obstetric anesthesia for patients with prior spinal surgery or spinal deformity. There have been even few prospective randomized studies. While its use may have significant advantages, it is not yet clear what those advantages are and in whom it may be most beneficial. The investigators seek to answer the following questions regarding the use of preprocedure ultrasound for neuraxial analgesia/anesthesia in obstetric patients:
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Are there benefits to the use of pre procedure ultrasound for neuraxial analgesia/anesthesia?
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If so, what are the benefits?
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If measurable, to what extent does the patient benefit?
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Do all patients benefit or only a specific subgroup?
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Is there a "cost" to the use of pre procedure ultrasound, i.e. extra time needed to perform the ultrasound exam vs a "savings" with the use of pre procedure ultrasound, i.e., less time to perform the epidural analgesic or spinal anesthetic as a direct result of the use of ultrasound?
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In particular the investigators hypothesize that in patients whose spinal landmarks are not palpable or are barely palpable, ultrasound will be found to be beneficial as determined by metrics described below (see item #6). In patients whose landmarks are prominent or easily palpable pre procedure ultrasound will not be of significant benefit.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Ultrasound Group Patients in the Ultrasound Group will have a pre-procedure ultrasound of the spine prior to needle placement |
Device: Ultrasound
Ultrasound examination of the lumbar spine. The level of the lumbar interspace will be determined by the oblique/sagittal method. The transverse method will be used to determine the best lumbar interspace and the distance from the skin to the target (epidural space or intrathecal space)
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| No Intervention: No Ultrasound Group Patients in the No Ultrasound Group will not have a pre-procedure ultrasound of the spine performed prior to needle placement. |
Outcome Measures
Primary Outcome Measures
- Number of attempts needed for proper needle placement [30 min or less]
An attempt is defined as a separate needle puncture. A needle pass is defined as the passage of a needle through a single puncture site
Secondary Outcome Measures
- Time [30 min]
The time for performance of an ultrasound exam as well as the time for needle placement for labor epidurals or spinal anesthesia
- Patient Satisfaction [30 min]
Patients will be given a questionaire grading their satisfaction on a 1 to 5 scale 1-very unsatisfied, 5-very satisfied
Eligibility Criteria
Criteria
Inclusion Criteria:
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Women in labor
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Women scheduled for cesarean delivery
Exclusion Criteria:
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Under age 18
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Emergency cesarean deliveries
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Unable to cooperate with ultrasound examination or regional anesthesia
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Advanced labor
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Contraindications to regional anesthesia
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Unable to understand the consent process
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Women's and Children's Hospital | Columbia | Missouri | United States | 65201 |
Sponsors and Collaborators
- University of Missouri-Columbia
Investigators
- Principal Investigator: Steven T Fogel, M.D., University of Missouri-Columbia School of Medicine
Study Documents (Full-Text)
None provided.More Information
Publications
- Arzola C, Davies S, Rofaeel A, Carvalho JC. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg. 2007 May;104(5):1188-92, tables of contents.
- Carvalho JC. Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin. 2008 Mar;26(1):145-58, vii-viii. doi: 10.1016/j.anclin.2007.11.007. Review.
- Chin KJ, Perlas A, Singh M, Arzola C, Prasad A, Chan V, Brull R. An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty. Can J Anaesth. 2009 Sep;56(9):643-50. doi: 10.1007/s12630-009-9132-8. Epub 2009 Jun 23.
- Grau T, Bartusseck E, Conradi R, Martin E, Motsch J. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anaesth. 2003 Dec;50(10):1047-50.
- Grau T, Leipold RW, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 2001 Jul;45(6):766-71.
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