Ultrasound-Guided Central Neuraxial Blocks

Chapter

Abstract

Central neuraxial blocks (CNBs; spinal and epidural) are techniques that are frequently used for anesthesia or analgesia in the perioperative period and for managing chronic pain. Success of these techniques depends on one’s ability to accurately locate the epidural or the intrathecal space. Traditionally, CNBs are performed using surface anatomical landmarks, fascial clicks, visualizing the free flow of cerebrospinal fluid (CSF) and “loss of resistance.” Although anatomical landmarks are useful they are often difficult to locate or palpate in patients with obesity, edema in their backs, and underlying spinal deformity or after spinal surgery. Even in the absence of the above, a given intervertebral space is accurately identified in only 30% of cases and anesthesiologists very frequently incorrectly identify a space higher than intended, which has been attributed as a cause for injury of the conus medullaris or spinal cord after spinal anesthesia.

Keywords

Obesity Catheter Syringe Dura Indigo 

Notes

Acknowledgment

All the figures have been reproduced with permission from www.aic.cuhk.edu.hk/usgraweb.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Anaesthesia and Intensive CareThe Chinese University of Hong Kong, Prince of Wales HospitalShatinHong Kong

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