Does Lumbar Ultrasonography Improve Epidural Catheterization for Labor Analgesia? a Randomized Controlled Study

Background: Palpation of anatomic landmarks is difficult in pregnant patients due to physiological changes. This can complicate epidural catheterization and determination of needle insertion site to place an epidural catheter. The purpose of our study was to compare prepuncture lumbar ultrasonography and palpation method for epidural needle insertion among pregnant. Methods: Forty parturients scheduled for labor analgesia were randomized into two groups: Ultrasound group (n=20) and control group (n=20). Needle insertion point was identified by lumbar ultrasonography in ultrasound group and by palpation in control group. We recorded number of puncture attempts, number of necessary puncture levels, epidural catheterization time and complications during epidural catheterization. Results: Number of puncture attempts was 1.35±0.58 in ultrasound group and 1.2±0.4 in control group. Number of puncture levels was 1.05±0.22 in ultrasound group and 1.10 ±0.3 in control group. Duration of epidural procedure was 93 seconds in ultrasound group and 88 seconds in control group. No statistically significant differences were found between the two groups. Sudden low back pain during needle insertion was significantly lower in ultrasound group (p=0.03). Conclusions: Pre-puncture lumbar ultrasonography lowered sudden back pain during needle insertion. Ultrasound guidance did not reduce number of puncture attempts, necessary puncture levels and time of epidural catheterization among normal weight pregnant.