The ultrasound-assisted paraspinous approach to lumbar neuraxial blockade: a simplified technique in patients with difficult anatomy

Acta Anaesthesiologica Scandinavica
K J ChinVincent W Chan

Abstract

Pre-procedural ultrasound imaging of the spine to identify the interspinous and interlaminar space has been shown to facilitate subsequent performance of lumbar neuraxial blockade. However, adequate visualization of the vertebral canal can be challenging for less-experienced operators, and particularly in subjects with difficult anatomy. In this case report, we describe a simplified technique of ultrasound-assisted neuraxial blockade that addresses these limitations and may thus be a useful fallback option. A pre-procedural scan is performed in which the main ultrasonographic landmarks to be identified are the neuraxial midline and the spinous processes, rather than the posterior and anterior complexes of the vertebral canal. Another key difference is the use of a paraspinous (or paramedian) needle approach rather than a midline approach that is advantageous where the interspinous spaces are narrowed by disease or suboptimal patient positioning. The anatomical basis and technical performance of this novel ultrasound-assisted paraspinous approach are presented in detail.

References

Nov 29, 2007·Anesthesia and Analgesia·Anna RabinowitzOlivier Fourcade
Dec 31, 2009·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Clarita B MargaridoJose C A Carvalho
Mar 23, 2010·Regional Anesthesia and Pain Medicine·Richard BrullCyrus C H Tse
Jun 17, 2010·Surgical and Radiologic Anatomy : SRA·Rolf SobottkePeer Eysel
Oct 1, 2011·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Caspar Edward William AylottCameron Walker
May 11, 2013·British Journal of Anaesthesia·C BowensJ M Corey
Apr 22, 2014·Regional Anesthesia and Pain Medicine·Kyle R Kirkham, Anahi Perlas
Dec 11, 2014·Regional Anesthesia and Pain Medicine·Anahi PerlasKi Jinn Chin

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