Ultrasound in Obstetric Anaesthesia- Neuraxial Blockade Dr John Loughrey The Rotunda Hospital...
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Ultrasound in Obstetric Anaesthesia-Neuraxial Blockade
Dr John Loughrey
The Rotunda HospitalDublin
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•Dober dan
•To bo dobro predavanje !
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Labour Epidural Rates
The Rotunda Hospital 67%
USA 66%
Ireland 33%
Europe 25%
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‘labour results in severe pain for many
women. There is no other circumstance where it is considered acceptable for a person to experience untreated severe pain,
amenable to safe intervention, while under a physician's care.’
American College of Obstetrics & Gynecology
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Methods of Maintaining Epidural Analgesia
• Intermittent ‘Top-Ups’• Continuous infusions (8-12 mls/hr)• Patient Controlled (PCEA)
– ± Background infusion
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Epidural Patient-Controlled Analgesia
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PCEA use: ~40% USA
Bucklin BA. Anesthesiology 2005;103:645-53Bucklin BA. Anesthesiology 2005;103:645-53
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PCEA vs Continuous Epidural infusion van der Vyver. BJA. 2002
• 9 Studies of 640 patients• Continuous vs PCEA with no basal rate• PCEA groups
– Less local anaesthetic– Less leg weakness– Fewer anaesthetic interventions
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Benefits of Minimising Local Anaesthetic Usage
• Patient Satisfaction• Ability to Void increased• Less Hypotension • Obstetric Outcome improved• Ambulation
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Ultrasound in Obstetric Anaesthesia
• Central Vascular Access• Abdominal field blocks eg: TAP• Pre-Anaesthesia clinic eg: scoliosis• Neuraxial Imaging• Pain Procedures eg: Sacroiliac/ Symphysis Injection
– Arch Physical Med & Rehab. Sept 2007.88(9) E45-6.– SOAP. 2009. A-206. Shannon J, Harmon D.
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Technique
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Equipment Cost
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“In the kingdom of the blind, the one-eyed man is King.”
D. Erasmus 1466-1536.
“An idiot with an ultrasound probe is still an idiot.”
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“ Evidence on Ultrasound-guided catheterisation of the epidural space is limited in amount, but suggests that it is safe and may be helpful in achieving correct placement.”
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Ultrasound in Neuraxial Anaesthesia
• Identifying Correct Lumbar Interspace• Identifying Skin Puncture site• Measuring depth to Epidural Space• Identifying aberrant Anatomy
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Lumbar Interspace Selection
Schlotterbeck H, Schaeffer R, Dow WA, et al (2008). Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia. British Journal of Anaesthesia 2008; 100: 230-4.
Reynolds F (2001). Damage to the conus medullaris following spinal anaesthesia. Anaesthesia 2001; 56: 238-247.
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Technique
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Technique
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Technique
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Efficacy of ultrasound imaging in obstetric epidural anesthesia . J Clin Anesth. 2002Thomas Grau, Rudiger Wolfgang Leipold , Renate Conradi, Eike Martin , Johann Motsch.
Ultrasound Using the Transverse Approach to the Lumbar Spine Provides Reliable Landmarks for Labor Epidurals. Anesthesia & Analgesia. May.2007.Cristian Arzola, Sharon Davies, Ayman Rofaeel, Jose Carvalho.
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Arzola et al. A&A. May 2007.
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Gaining Experience
• Appropriate specification equipment• Use in non-neuraxial anaesthesia• Outpatient evaluations• Pre-puncture imaging
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“ Gentlemen…this is no humbug!”
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Hvala lepa !