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Xu CY, Liu C, Jin XJ, Yang F, Xu F, Qian WD, Guo WJ. Anatomical dimensions of the lumbar dural sac predict the sensory block level of continuous epidural analgesia during labor. BMC Anesthesiol 2021; 21:268. [PMID: 34736416 PMCID: PMC8567596 DOI: 10.1186/s12871-021-01485-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The anatomical dimensions of the lumbar dural sac determine the sensory block level of spinal anesthesia; however, whether they show the same predictive value during continuous epidural anesthesia (CEA) remains undetermined. We designed the present study to verify the efficacy of the anatomical dimensions of the lumbar dural sac in predicting the sensory block level during labor analgesia. METHODS A total of 122 parturients with singleton pregnancies requesting labor analgesia were included in this study. The lumbar dural sac diameter (DSD), lumbar dural sac length (DSL), lumbar dural sac surface area (DSA), and lumbar dural sac volume (DSV) were measured with an ultrasound color Doppler diagnostic apparatus. CEA was performed at the L2-L3 interspace. After epidural cannulation, an electronic infusion pump containing 0.08% ropivacaine and sufentanil 0.4 μg/ml was connected. The sensory block level was determined with alcohol-soaked cotton, a cotton swab, and a pinprick. The analgesic efficacy of CEA was determined with a visual analog scale (VAS). The parturients were divided into two groups, "ideal analgesia" and "nonideal analgesia," and the groups were compared by t test. Pearson's correlation was performed to evaluate the association between the anatomical dimensions of the lumbar dural sac and sensory block level. Multiple linear regression analysis was used to create a model for predicting the sensory block level. RESULTS In the ideal analgesia group, the height, DSL, DSA, DSV and DSD were significantly smaller, and the body mass index (BMI) was significantly larger (P < 0.05). In addition, the DSL demonstrated the strongest correlation with the peak level of pain block (r = - 0.816, P < 0.0001; Fig. 2A), temperature block (r = - 0.874, P < 0.0001; Fig. 3A) and tactile block (r = - 0.727, P < 0.0001; Fig. 4A). Finally, the multiple linear regression analysis revealed that DSL and BMI contributed to predicting the peak sensory block level. CONCLUSION In conclusion, our study shows that the sensory block level of CEA is higher when the DSL, DSA, DSV and DSD of puerperae are lower. DSL and BMI can be treated as predictors of the peak sensory block level in CEA during labor analgesia.
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Affiliation(s)
- Chen-Yang Xu
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China.,Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu Province, China
| | - Can Liu
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China
| | - Xiao-Ju Jin
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China
| | - Fan Yang
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China
| | - Fang Xu
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China
| | - Wan-Di Qian
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China
| | - Wen-Jun Guo
- Department of Anesthesiology, the First Affiliated Hospital of Wannan Medical College, No. 2, Zheshan West Road, Jinghu District, Wuhu City, Anhui Province, China.
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Cantürk M, Kocaoğlu N, Hakki M. [Correlation of the epidural space measured intraoperatively and estimated by MRI or US: an observational study]. Rev Bras Anestesiol 2020; 70:248-255. [PMID: 32711869 DOI: 10.1016/j.bjan.2020.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 02/25/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the agreement between the epidural depth measured from the surgical site with the epidural depths estimated with magnetic resonance imaging (MRI) and ultrasound scanning. METHODS Fifty patients of either sex, scheduled for L4-5 lumbar disc surgery under general anesthesia were enrolled in this prospective observational study, and the results of 49 patients were analyzed. The actual epidural depth was measured from the surgical site with a sterile surgical scale. The MRI-derived epidural depth was measured from the MRI scan. The ultrasound estimated epidural depth was measured from the ultrasound image obtained just before surgery. RESULTS The mean epidural depth measured from the surgical site was 53.80 ± 7.67mm, the mean MRI-derived epidural depth was 54.06 ± 7.36mm, and the ultrasound-estimated epidural depth was 53.77 ± 7.94mm. The correlation between the epidural depth measured from the surgical site and MRI-derived epidural depth was 0.989 (r2 = 0.979, p < 0.001), and the corresponding correlation with the ultrasound-estimated epidural depth was 0.990 (r2 = 0.980, p < 0.001). CONCLUSIONS Both ultrasound-estimated epidural depth and MRI-derived epidural depth have a strong correlation with the epidural depth measured from the surgical site. Preprocedural MRI-derived estimates of epidural depth are slightly deeper than the epidural depth measured from the surgical site, and the ultrasound estimated epidural depths are somewhat shallower. Although both radiologic imaging techniques provided reliable preprocedural estimates of the actual epidural depth, the loss of resistance technique cannot be discarded while inserting epidural needles.
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Affiliation(s)
- Mehmet Cantürk
- Ahi Evran University Training and Research Hospital, Department of Anesthesiology and Reanimation, Kırsehir, Turquia.
| | - Nazan Kocaoğlu
- Balikesir University Faculty of Medicine, Department of Anesthesiology and Reanimation, Balikesir, Turquia
| | - Meltem Hakki
- Ahi Evran University Training and Research Hospital, Department of Anesthesiology and Reanimation, Kırsehir, Turquia
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Cantürk M, Kocaoğlu N, Hakki M. Correlation of the epidural space measured intraoperatively and estimated by MRI or US: an observational study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2020. [PMID: 32711869 PMCID: PMC9373217 DOI: 10.1016/j.bjane.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background and objectives To assess the agreement between the epidural depth measured from the surgical site with the epidural depths estimated with magnetic resonance imaging (MRI) and ultrasound scanning. Methods Fifty patients of either sex, scheduled for L4‒5 lumbar disc surgery under general anesthesia were enrolled in this prospective observational study, and the results of 49 patients were analyzed. The actual epidural depth was measured from the surgical site with a sterile surgical scale. The MRI-derived epidural depth was measured from the MRI scan. The ultrasound estimated epidural depth was measured from the ultrasound image obtained just before surgery. Results The mean epidural depth measured from the surgical site was 53.80 ± 7.67 mm, the mean MRI-derived epidural depth was 54.06 ± 7.36 mm, and the ultrasound-estimated epidural depth was 53.77 ± 7.94 mm. The correlation between the epidural depth measured from the surgical site and MRI-derived epidural depth was 0.989 (r2 = 0.979, p < 0.001), and the corresponding correlation with the ultrasound-estimated epidural depth was 0.990 (r2 = 0.980, p < 0.001). Conclusions Both ultrasound-estimated epidural depth and MRI-derived epidural depth have a strong correlation with the epidural depth measured from the surgical site. Preprocedural MRI-derived estimates of epidural depth are slightly deeper than the epidural depth measured from the surgical site, and the ultrasound estimated epidural depths are somewhat shallower. Although both radiologic imaging techniques provided reliable preprocedural estimates of the actual epidural depth, the loss of resistance technique cannot be discarded while inserting epidural needles.
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