Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942010000400004
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação da profundidade do espaço peridural com o uso do ultrassom

Evaluating the depth of the epidural space with the use of ultrasound

Pablo Escovedo Helayel; Diogo Bruggemann da Conceição; Gustavo Meurer; Claudia Swarovsky; Getúlio Rodrigues de Oliveira Filho

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Resumo

JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi avaliar o uso do ultrassom na determinação da profundidade do espaço peridural. MÉTODO: Sessenta pacientes foram alocados prospectivamente tendo a identificação do espaço intervertebral L3-L4 inicialmente feita pelo método palpatório. Posteriormente, utilizou-se o método ultrassonográfico, realizando-se a medida da profundidade do espaço peridural (PU). Após a punção peridural, foram anotadas as medidas da profundidade (PA). Realizaram-se estatísticas descritivas dos dados e calculou-se o coeficiente de correlação de concordância e análise de Bland-Altman, com intervalo de 95% de confiança para as medidas de profundidade. RESULTADOS: A análise de concordância entre o método palpatório e ultrassonográfico foi de 86,6%. Foram obtidos valores médios de PU 4,97 ± 0,51 cm e PA 4,97 ± 0,71 cm e coeficiente de correlação de Pearson de 0,66, enquanto a análise Bland-Altman revelou diferença média de 0,0035 ± 0,53 cm, com limite de 95% de confiança entre -0,228 a 0,221. CONCLUSÕES: A ultrassonografia é uma ferramenta precisa para a determinação da profundidade do espaço peridural.

Palavras-chave

EQUIPAMENTOS, Ultrassom, METODOLOGIA, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The objective of the present study was to evaluate the use of the ultrasound on the determination of the depth of the epidural space. METHODS: Sixty patients were included in this prospective study; the L3-L4 space was initially identified by palpation followed by the ultrasound measuring the depth of the epidural space (PU). After the epidural puncture the measurements o the depth (PA) were recorded. The data underwent descriptive statistics, and the concordance correlation coefficient and Bland-Altman analysis, with 95% confidence interval were calculated. RESULTS: Analysis of concordance between the palpation and ultrasound methods was 86.6%. Mean values of PU obtained were 4.97 ± 0.51 cm and PA 4.97 ± 0.71 cm, and Pearson correlation coefficient of 0.66 while Bland-Altman analysis revealed a mean difference of 0.0035 ± 0.53 cm with 95% confidence interval between -0.228 and 0.221. CONCLUSIONS: The ultrasound is a precise tool to determine the depth of the epidural space.

Keywords

ANESTHETIC TECHNIQUES, Regional, EQUIPMENT, Ultrasound, METHODOLOGY

References

Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002;57:277-280.

Broadbent C. Ability of anaesthetists to identify a marked lumbar interspace. Pain Practice. 2001;1.

Bevacqua BK, Haas T, Brand F. A clinical measure of the posterior epidural space depth. Reg Anesth. 1996;21:456-460.

Sutton DN, Linter SP. Depth of extradural space and dural puncture. Anaesthesia. 1991;46:97-98.

Hamza J, Benhamou D. Dural puncture and depth of the extradural space. Anaesthesia. 1992;47:169-170.

Oliveira Filho GR, Gomes HP, Fonseca MHZ. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002;19:447-451.

Grau T, Leipold RW, Conradi R. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 2001;45:766-771.

Cork RC, Kryc JJ, Vaughan RW. Ultrasonic localization of the lumbar epidural space. Anesthesiology. 1980;52:513-516.

Currie JM. Measurement of the depth to the extradural space using ultrasound. Br J Anaesth. 1984;56:345-347.

Helayel PE, Conceição DB, Oliveira Filho GR. Bloqueios nervosos guiados por ultrassom. Rev Bras Anestesiol. 2007;57:106-123.

Arzola C, Davies S, Rofaeel A. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg. 2007;104:1188-1192.

Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135-160.

Balki M, Lee Y, Halpern S. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 2009;108:1876-1881.

Oliveira Filho GR, Boso AL, Benedetti RH. Distância da pele ao espaço subaracnoideo em pacientes geriátricos: comparação entre os acessos mediano e paramediano. Rev Bras Anestesiol. 1997;47:226-230.

Grau T, Leipold R, Conradi R. Ultraschall und Periduralanasthesie: Technische Moglichkeiten und Grenzen einer diagnostischen Untersuchung des Periduralraums. Anaesthesist. 2001;50:94-101.

Grau T, Leipold RW, Conradi R. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med. 2001;26:64-67.

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