I have had a few readers ask questions about the use of ultrasound for the difficult epidural – usually in the labour ward context, but we sometimes run into this in the OT for combined spinal-epidural blocks. Now I love all things ultrasound – but looking at the literature it is tough to get a read on the utility of US in the often troublesome area of epidurals. All those bones – can we see anything useful? So I have asked an expert, and gotten a few handy, practical pointers.
Dr Chris Mitchell is a Consultant Anaesthestist at King Edward Memorial Hospital for Women in Perth, Western Australia. But Mitch is more than an Anaesthetist – before he went into specialist training Chris was a rural GP-Anaesthetist in NW WA. In fact my first job after my training in Anaesthesia I actually replaced Chris!
Now onto the meat of the post – here are Chris’s tips in beautifully illustrated form – click here [US for Epidurals]
I think it should be said – epidurals in the labour ward are an elective procedure. There is a risk : benefit pay off. If you are increasing the risk side of the equation as a result of a difficult insertion, then you need to discuss that with the patient – so before calling for he US machine I think it is worth a pause to consider if this is worth a try – I am sure that for the occasional operator this technique wil help, but is no magic bullet!
We usually try and avoid the patients with really tough anatomy – if the BMI is over 35 we usually start to strongly consider referral to a larger institution for a whole raft of safety reasons.
Huge thanks to Dr Mitch for his pearls on epidurals and US. I would love to hear your experiences and if you have any questions for Chris I will pass them along. Comments please