Pre-Procedure Neuraxial Ultrasound in Obstetric Anesthesia

Abstract

bstetric patients present unique challenges in providing neuraxial (spinal or epidural) blockade. Neuraxial anesthesia offers analgesia and anesthesia for labor, vaginal delivery, cesarean section, and is considered the gold standard because of its limited effects on both the mother and fetus. Neuraxial analgesia/anesthesia relies primarily on the palpation of anatomical landmarks, which can be obscured in the setting of obesity, edema, and anatomical variation (1). Pregnancy is associated with generalized tissue edema, weight gain, and an exaggerated lordosis which can make palpation and identification of anatomic landmarks very challenging. Further-more, the hormonal changes of pregnancy cause ligaments to soften which can alter the tactile sen-sation of the dural ligament making the epidural space harder to identify. These changes narrow the epidural space causing the intrathecal space to become smaller increasing the risk for inadver-tent dural puncture (2). Parturients may also have difficulty achieving and maintaining ade-quate flexion of the lumbar spine for neuraxial insertion because of the gravid uterus and/or severe pain from contractions (2). None-the-less, repeated needle insertions and redirections can further increase the pain and discomfort already experienced by the parturient in labor (1). Ultrasound imaging for clinical procedures popularity decade