J Anesth Perioper Med. 2018;5(2):70-76. https://doi.org/10.24015/ebcmed.japm.2018.0031

Real-Time Ultrasound-Guided Paramedian Epidural Access Using a Paramedian Transverse Oblique Scan: A Prospective Case Series

Yun Wang1, Geng Wang2, Danxu Ma1, and Huili Li1

From the 1Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, 2Department of Anesthesiology, Beijing Jishuitan Hospital, both in Beijing, China.

Correspondence to Dr. Yun Wang at wangyun129@ccmu.edu.cn.

EBCMED ID: ebcmed.japm.2018.0031 DOI: 10.24015/ebcmed.japm.2018.0031


Current methods for the real-time ultrasound (US) -guided epidural access face a challenge in clinical practice. In the study, we described a new US-guided technique for epidural access through a paramedian transverse scan at the level of articular process, with the needle in the plane of the US beam.

A total of 18 American Society of Anesthesiologists physical status I to III patients with body mass index of less than 28 kg/m2 scheduled for lower extremity surgery received the US scout scan. And then the combined spinal and epidural anesthesia was performed in patients with successful US scout scan. We evaluated the feasibility of performing real-time US-guided epidural access using the technique described.

The US scout scan was successful in 16 out of 18 (88.8%) patients, in whom the articular process, ligamentum flavum, posterior dura, intrathecal space and anterior dura were visualized. The epidural space was visualized in 14 out of 16 (87.5%) patients with successful scout scan. The US visibility of spinal and neuraxial structures in patients with successful scout scan was judged as good in 14 (14/16, 87.5%), and average in 2 (2/16, 12.5%) patients. After sterile preparation, the epidural space was successfully identified in all patients with successful scout scan in 1 attempt using real-time ultrasound guidance and loss of resistance technique. There was a failure to observe the phenomena of the efflux of cerebrospinal fluid from the spinal needle in 2 patients. There were no inadvertent dura punctures or complications directly related to the technique described. Satisfactory anesthesia developed in all patients and recovery from the spinal anesthesia was uneventful.

We have demonstrated the feasibility of a new in-plane, single-operated technique for real-time US-guided paramedian epidural access through paramedian transverse oblique scan in patients. (Funded by the Program for High Levels of Health Personnel in Beijing, China.)

Article Type
Original Article

Declaration of Interests
The authors declare no other conflicts of competing interest for this work.

This work was supported by a grant from the Program for High Levels of Health Personnel in Beijing, China (in the year of 2013 for Dr. Yun Wang).

This is an open-access article, published by Evidence Based Communications (EBC). This work is licensed under the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium or format for any lawful purpose. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.