Comparison of Patient Position and Midline Lumbar Neuraxial Access Via Statistical Model Registration to Ultrasound

• Published in: Ultrasound in medicine & biology Vol. 45; no. 1; pp. 255 - 263
• Main Authors: Porto, Lucas Resque, Tang, Raymond, Sawka, Andrew, Lessoway, Victoria, Anas, Emran Mohammad Abu, Behnami, Delaram, Abolmaesumi, Purang, Rohling, Robert
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.01.2019
• Subjects: Anesthesia, Spinal - instrumentation; Anesthesia, Spinal - methods; Computed tomography; Epidural Space - diagnostic imaging; Humans; Image registration; Lumbar spine; Lumbar Vertebrae - diagnostic imaging; Lumbosacral Region - diagnostic imaging; Medical image computing; Neuraxial anesthesia; Patient positioning; Patient Positioning - methods; Posture; Reproducibility of Results; Ultrasonography, Interventional - methods; Ultrasound; Image registration; Lumbar spine; Computed tomography; Medical image computing; Neuraxial anesthesia; Patient positioning; Ultrasound
• ISSN: 0301-5629; 1879-291X
• DOI: 10.1016/j.ultrasmedbio.2018.08.016

Patient positioning and needle puncture site are important for lumbar neuraxial anesthesia. We sought to identify optimal patient positioning and puncture sites with a novel ultrasound registration. We registered a statistical model to volumetric ultrasound data acquired from volunteers (n = 10) in three positions: (i) prone; (ii) seated with thoracic and lumbar flexion; and (iii) seated as in position ii, with a 10° dorsal tilt. We determined injection target size and penetration success by simulating lumbar injections on validated registered models. Injection window and target area sizes in seated positions were significantly larger than those in prone positions by 65% in L2–3 and 130% in L3–4; a 10° tilt had no significant effect on target sizes between seated positions. In agreement with computed tomography studies, simulated L2–3 and L3–4 injections had the highest success at the 50% and 75% midline puncture sites, respectively, measured from superior to inferior spinous process. We conclude that our registration to ultrasound technique is a potential tool for tolerable determination of puncture site success in vivo.