Novel 3D ultrasound system for midline single-operator epidurals: a feasibility study on a porcine model
| Autor: | J. Stone, Vit Gunka, Victoria A. Lessoway, Parmida Beigi, A. Dube, Robert Rohling |
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| Rok vydání: | 2016 |
| Předmět: |
Anesthesia
Epidural Epidural Space medicine.medical_specialty Swine 0206 medical engineering Insertion site 02 engineering and technology 03 medical and health sciences 0302 clinical medicine Lumbar Imaging Three-Dimensional 030202 anesthesiology medicine Anesthesia Obstetrical Animals 3D ultrasound Ultrasonography Interventional Observer Variation medicine.diagnostic_test business.industry Ultrasound Visibility (geometry) Lumbosacral Region Obstetrics and Gynecology Echogenicity 020601 biomedical engineering Epidural space Independent Assessor Anesthesiology and Pain Medicine medicine.anatomical_structure Needles Feasibility Studies Female Radiology business |
| Zdroj: | International journal of obstetric anesthesia. 31 |
| ISSN: | 1532-3374 |
| Popis: | We developed a real-time 3D ultrasound thick slice rendering technique and innovative Epiguide needle-guide as an adjunct to single-operator midline epidural needle insertions. Study goals were to determine feasibility of the technique in a porcine model and compare the visibility of standard and echogenic needles.Thirty-four lumbar needle insertions were performed on six intact porcine spines ex vivo. Ultrasound scanning identified the insertion site and, using an Epiguide, the needle was guided into the epidural space through the ligamentum flavum in the midline plane, watched in real-time on the 3D ultrasound. Entry into the epidural space was judged by a loss-of-resistance technique. Needle visibility was rated by the anesthesiologist performing the technique using a 4-point scale; (0=cannot see, 1=poor, 2=satisfactory, 3=excellent), and later by an independent assessor viewing screenshots. The procedure was repeated at all lumbar levels using either the standard or echogenic needle.Successful loss-of-resistance to fluid was achieved in 76% of needle insertions; needle visibility with echogenic needles (94.2% rated satisfactory/excellent) was significantly better than with standard needles (29.4% satisfactory/excellent, P0.0001). Successful loss-of-resistance was 93% when mean needle visibility was rated as 'excellent'. Inter-observer agreement between assessors was 'near-perfect' (weighted kappa=0.83).It is feasible to perform 3D ultrasound-guided real-time single-operator midline epidural insertions, in a porcine model. Echogenic needles were found to consistently improve needle visibility; and improved needle visibility tended to increase successful entry into epidural space. |
| Databáze: | OpenAIRE |
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