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Role Of ultrasound In central neuraxial blockade

Abdul Ghani, Muhamad Rasydan Role Of ultrasound In central neuraxial blockade. In: UNSPECIFIED UNSPECIFIED.

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Standard practice central neuraxial blocks (CNB) commonly performed in sitting position involves using surface landmark technique (identification of Tuffier’s line), operators feeling of tactile sensation and or seeing free flow of cerebrospinal fluid (CSF). Although identification of spinous process are very reliable, surface anatomy landmarks sometimes are not always easily identified, especially in patients with spinal deformity, for example kyphoscoliosis, obesity, oedema or previous back surgery.1,2 Tuffier’s line, a line drawn between the highest point of iliac crests is widely used as estimation of L3 - L4 interspace, but the correlation is inconsistent.3 The precision of identification varies and inaccurate in many patients may end up needle placement one or two spinal levels higher.1,2,4-7 Surface landmark technique does not give the anaesthesiologist reliability to locate the space for needle insertion, predict ease of needle placement and avoiding accidental dural puncture during epidural insertion. Ultrasound imaging can be used to preview the underlying spinal anatomy (pre-procedural scan) or guide the spinal needle in real-time during performing CNB. The ultrasound can 60% correctly identified L2 - L3 interspace, with margin of error 7 - 9% either one space above or below, in comparison with clinical assessment 9 - 18% up to 2 spaces higher or lower (more significant variability).10 With pre-procedural ultrasound scan, the reliability of identification of the L3-L4 interspace increases to almost 70 - 80%. An anaesthesiologist can identify the midline of the spine accurately, identify the correct lumbar interspace, measure and predict skin to space distance and identify patients with potentially difficult CNB.1,2,8,9,11

Item Type: Book Chapter
Uncontrolled Keywords: Ultrasound, Central Neuraxial Blockade
Subjects: R Medicine > RC Internal medicine > RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
R Medicine > RZ Other systems of medicine
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): UNSPECIFIED
Depositing User: Dr Muhamad Rasydan Abdul Ghani
Date Deposited: 08 Jan 2021 19:01
Last Modified: 27 Jan 2021 17:22
URI: http://irep.iium.edu.my/id/eprint/87623

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