Document Detail


Ultrasound decreases the failed labor epidural rate in resident trainees.
MedLine Citation:
PMID:  20696564     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Epidural analgesia is widely used for pain relief during labor. The purpose of this study was to determine if ultrasound measurement of the depth from skin to epidural space before the epidural technique decreases the failure rate of labor analgesia. A secondary objective was to correlate ultrasound depth to the epidural space with actual depth of the needle at placement.
METHODS: In this prospective, randomized, non-blinded study, 370 parturients requesting labor epidural analgesia were randomized to receive their epidural technique by first year anesthesia residents with or without prior ultrasound determination of epidural space depth. Outcome variables included the incidence of epidural catheter replacement for failed analgesia and the number of epidural attempts and accidental dural punctures.
RESULTS: The ultrasound group had fewer epidural catheter replacements (P<0.02), and epidural placement attempts (P<0.01) compared to the control group. Pearson's correlation coefficients comparing the actual versus ultrasound estimated depth to the epidural space in the longitudinal median and transverse planes were 0.914 and 0.909, respectively. Pearson's correlation coefficient comparing the ultrasound estimated depths to the epidural space in the transverse and longitudinal median planes was 0.940. No significant differences were noted with respect to staff interventions, top-ups, accidental dural punctures, and delivery outcome.
CONCLUSIONS: Ultrasound measurement of the epidural space depth before epidural technique placement decreases the rate of epidural catheter replacements for failed labor analgesia, and reduces the number of epidural attempts when performed by first year residents and compared to attempts without ultrasound guidance.
Authors:
M C Vallejo; A L Phelps; S Singh; S L Orebaugh; N Sah
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2010-08-08
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  19     ISSN:  1532-3374     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-27     Completed Date:  2011-01-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  373-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
Affiliation:
Magee-Womens Hospital, Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA. vallejomc@anes.upmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Anesthesia, Epidural / methods*
Anesthesia, Obstetrical / methods*
Catheters
Double-Blind Method
Epidural Space / ultrasonography*
Female
Humans
Internship and Residency
Linear Models
Medical Errors / statistics & numerical data
Needles
Pregnancy
Prospective Studies
Treatment Failure

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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