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British Journal of Anaesthesia 2008 100(2):230-234; doi:10.1093/bja/aem371
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia

H. Schlotterbeck1, R. Schaeffer1, W. A. Dow1,2, Y. Touret1, S. Bailey1 and P. Diemunsch1,*

1 Department of Anesthesiology, Hautepierre University Hospital, Strasbourg, France
2 Department of Anaesthesia, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK

* Corresponding author: Professeur, Service d'Anesthésie Réanimation Chirurgicale, CHU de Hautepierre, 67000 Strasbourg, France. E-mail: pierre.diemunsch{at}chru-strasbourg.fr

Background: Errors in the judgement of puncture level during neuraxial anaesthesia can lead to significant complications. The aim of this study was to assess, in obstetric anaesthesia, the accuracy of clinical determination of the lumbar spinal interspace level, using surface ultrasound imaging as control.

Methods: At the anaesthesia follow-up visit, women who had received lumbar neuraxial anaesthesia during labour were prospectively included. The intervertebral level of needle insertion, located by the needle scar position, was identified by ultrasonography and compared with the clinical level reported on the chart by the anaesthetist who performed the block.

Results: Ninety-nine women were studied. The clinical puncture level was accurate in 36.4% of patients. Ultrasound examination showed the puncture level to be more cephalad than the level noted in the anaesthetic record in almost 50% of patients. In 15% of patients, the puncture level was more caudad than the anaesthetist had assessed. Factors including type of anaesthesia, indication, time period, level of anaesthetic experience, BMI, and spinal pathology did not seem to influence the frequency of errors.

Conclusions: The observed differences between clinical and ultrasonic identification of spinal puncture level highlight the potential for serious complications associated with the performance of neuraxial blocks above the spinous process of L3 in the parturient. With the increase in popularity of techniques involving puncture of the dura mater for labour anaesthesia, we feel that awareness of this risk is important.

Keywords: anaesthesia, obstetric; anaesthetic techniques, regional; equipment, ultrasound machines


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This article has been cited by other articles:


Home page
 Br J AnaesthHome page
T. Kathirgamanathan, H. Schlotterbeck, R. Schaeffer, W. A. Dow, Y. Touret, S. Bailey, and P. Diemunsch
Ultrasound technique for neuraxial procedures
Br. J. Anaesth., June 1, 2008; 100(6): 860 - 861.
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Ultrasound technique for neuraxial procedures
Thillaiampalam Kathirgamanathan
British Journal of Anaesthesia, 18 Feb 2008 [Full text]
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Herve Schlotterbeck, et al.
British Journal of Anaesthesia, 1 Mar 2008 [Full text]

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