Induction of Ultrasound Guidance for Catheterization of the Epidural Space

Abstract

  Recently, ultrasound imaging has been used to assist or guide epidural block, and it appears to be a promising alternative to the traditional landmark-based technique. A pre-puncture scout scan allows the operator to determine the optimal puncture point, as well as the trajectory and depth of the needle insertion. Therefore, it may reduce the length of the procedure and improve it by avoiding multiple attempts at needle placement, pain and discomfort to the patient, injury to soft tissue structures that lie in the path of the advancing needle, a failed block, and frustration for the anesthesiologist.
  In January 2008, NICE (National Institute for Health and Clinical Excellence of the United Kingdom) produced the guidance: ultrasound-guided catheterization of the epidural space may be helpful in achieving correct placement.
  Acknowledging the guidance, we have conduct the procedure using the paramedian oblique sagittal view of ultrasound from May 2008. In this article, we describe the pitfall and problems with it, from our 18 months' experience.