Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

Jian-Ping Wu; Yuan-Zhang Tang; Liang-Liang He; Wen-Xing Zhao; Jian-Xiong An; Jia-Xiang Ni

doi:10.12998/wjcc.v9.i21.5900

Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia

World J Clin Cases. 2021 Jul 26;9(21):5900-5908. doi: 10.12998/wjcc.v9.i21.5900.

Authors

Jian-Ping Wu¹, Yuan-Zhang Tang¹, Liang-Liang He¹, Wen-Xing Zhao², Jian-Xiong An², Jia-Xiang Ni³

Affiliations

¹ Department of Pain Management, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.
² Department of Anesthesiology and Pain Medicine, Aviation General Hospital of China Medical University, Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China.
³ Department of Pain Management, Xuanwu Hospital of Capital Medical University, Beijing 100053, China. nijiaxiang@263.net.

Abstract

Background: For parturients with paroxysmal uterine contraction pain, rapid analgesia is needed. We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor, and evaluated the usefulness of this technique in epidural labor analgesia.

Aim: To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.

Methods: In this prospective randomized observational study, 72 parturients were assigned to two groups (combined or palpation group). The target interspace of all parturients was first identified by the palpation technique. Then in the combined group, preprocedure ultrasound imaging was used before epidural puncture. In the palpation group, only the traditional anatomical landmarks technique (palpation technique) was performed. The primary outcome was total duration of the epidural procedure (for the ultrasound group, the duration of the preprocedure ultrasound imaging was included). The secondary outcomes were the number of skin punctures, the success rate at first needle pass, the number of needle passes, the depth from the skin to epidural space, and the complications of the procedure.

Results: Total duration of the epidural procedure was similar between the two groups (406.5 ± 92.15 s in the combined group and 380.03 ± 128.2 s in the palpation group; P = 0.318). A significant improvement was demonstrated for epidural puncture and catheterization in the combined group. The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group (P = 0.001). The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group (P = 0.398). The success rate at first needle pass was 88.89% in the combined group and 66.67% in the palpation group (P = 0.045).

Conclusion: This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique, which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Keywords: Epidural catheterization; Epidural puncture; Labor analgesia; Palpation technique; Preprocedure ultrasound imaging.