The Use Of Assisted Pre-Procedural Ultrasonography Versus Landmark Technique in Identifying Epidural Space in Women Requesting Labor Analgesia

Syed Aqib Ali Shah; Muhammad Rashid Iqbal; Rao Ali Shan Khan; Ghulam Sabir; Ameer Yasser Zaid; Shahzad Ahmed Qasmi

doi:10.51253/pafmj.v76i4.11172

Authors

Syed Aqib Ali Shah Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Muhammad Rashid Iqbal Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Rao Ali Shan Khan Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ghulam Sabir Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Ameer Yasser Zaid Department of Anesthesia, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Shahzad Ahmed Qasmi Department of Spine Surgery, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i4.11172

Keywords:

Analgesia, Epidural, Labour, Ultrasonography USG guided epidural

Abstract

Objective: To compare whether the use of ultrasonography (USG) is superior to blind landmark technique in correctly identifying epidural space in pregnant patients requesting labor analgesia through epidural catheter.

Study Design: Prospective analytical study (IRCT20230819059186N1)

Place and Duration of Study: Anesthesia Department of Combined Military Hospital, Rawalpindi Pakistan from Apr 2023 to Oct 2023

Methodology: A total of 250 patients were included in the study protocol divided into Group U (n=125) and Group L (n=125). Primary variables measured were mean number of tries for epidural insertion (taking the needle out and then re-introduction), mean number of needle re-directions (without taking out from skin), difference between actual measured needle length (AML) versus USG measured needle length (UML) and number of dural punctures between the USG and landmark Group.

Results: Mean needle attempts of 1.27±0.44 in Group U versus 1.74±0.60 in Group L (p<0.001). Success of needle attempts was in 91(72.8%) patients in the first and 34(27.2%) patients in the second attempt in Group U versus 43(34.4%) patients in the first, 71(56.8%) in the second and 11(8.8%) in more than two attempts in Group L (p=0.022). There was a statistically significant and positive co-relation between both measured lengths with a Pearson co-efficient (r) value of 0.828

Conclusion: We conclude that USG guided epidural insertion provides better rates of success in identifying epidural space as well as less chances of complications in parturients requiring labor analgesia.

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