Page 11 - 麻醉与监护论坛2016年第2期

Using ultrasound to locate the puncture site for combined
spinal-epidural anesthesia in cesarean sections

Wang Changshe1,Li Shenghua1,Li Qin2,Sun Lianyi2

1. Department of anesthesiology,2.Department of Image Section,Maternal and Child Health Care Hospital of Jiading
District,Shanghai China

Abstract

Objective: To investigate the value of ultrasound imaging technique to locate the puncture site for combined spinal-
epidural anesthesia in cesarean section.
Methods: 240 pregnant women were randomly divided into group 1 and group 2(120 each). We used the anterior
superior spine to locate the L3-L4 space in group 1, and used the ultrasound imaging technique to locate the L3-L4 space
in group 2. When we finished the combined spinal-epidural anesthesia, and evaluated the anesthetic effect before the
cesarean section. The age, height, weight,body mass index of the pregnant women, and the time to locate the L3-L4
space were recorded. The numbers of attempting to complete combined spinal-epidural anesthesia in two groups were
observed. Measured the distance of the skin to the epidural space by ultrasound in group 2, and the needle length in
both group. Bleeding in epidural catheter, neurological symptoms was induced by the epidural catheter or spinal needle
when inserted into the epidural or subarachnoid space. The number of patients with post dural puncture headache, nerve
irritation, backache and lower extremity sensory or motor abnormalities at the 1st, 3rd, 7th days postoperatively were
recorded.
Results: The time to locate the puncture site of L3-L4 space in group 2 was longer than group 1(P<0.01). The successful
rate of the first attempting for combined spinal-epidural anesthesia in group 2 was higher than group 1(P<0.01). The
anesthesia related complication in group 1 was higher than group 2(P<0.01).
Conclusion: When used ultrasound imaging technique to locate the L3-L4 space,it can help to improve the success rate of
combined spinal-epidural anesthesia, and reduce complications associated with anesthesia. Ultrasound imaging technique
is a useful tool for anesthetists.
KEY WORDS: Ultrasound imaging technology; puncture success rate; Combined spinal-epidural anesthesia; Cesarean
section; Complications

Potable ultrasonic instrument was increasingly signing of informed consent by the patients, we need
used in many fields of anesthesia, such as guided 240 pregnant women for elective cesarean delivery
nerve bock or establishing artery and deep venous in our study. Inclusion criteria were as follow: 20
access, but only a few anesthetist use the ultrasound to 35 years old, the weight is 52 to 100 kilograms,
to locate the puncture site for combined spinal- the height is 150 to 175 centimeter, gestational
epidural anesthesia. We used the ultrasound to weeks is 37 to 42, single birth, no contraindications
locate the puncture site before anesthesia procedure, for combined spinal-epidural anesthesia (infection
it can help us to improve the puncture success rate of at the puncture site, coagulopathy, patient refusal
the combined spinal-epidural anesthesia at the first or abnormal spinal anatomy) and obstetrical
time, reduce the complications related anesthesia complications (gestational hypertension,
and increase the patients satisfaction. hyperthyroidism, hypothyroidism, glycuresis or
heart disease). All the parturients were fasting at
Materials and Methods 6 hours. All the patients were established reliable
venous access and monitored with pulse oximeter,
After our hospital ethics committee approval and

Laboratory and ClinicalCInovveesrtTighaetsioisn 20 FAM 2016 Jan/Feb Vol.23 Issue 1
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