Ultrasound for epidurals

[caligas]

Anyone using?

Worth learning for the remainder of my OB anesthesia career? (maybe 5 years before I refuse to do it anymore 😀)

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[Hork Bajir]

Short answer- no

Long answer- on very rare occasions it might be useful (for example finding midline and getting a rough sense of depth in the BMI 60 patient with scoliosis)… but in order for it to be useful in the situation, you have to spend a lot of time practicing with it on easier patients, which is a giant waste of time and complicates things unnecessarily

 

[dabears505]

If you have 5 years left, that means you've been practicing for quite a while and are pretty good at epidurals. I would not bother.

 

[linkin06]

I’ve been thinking and trying to learn to use it to find midline. Some are able to find depth of epidural space but I think midline info is probably 80% informative and relatively easy.

 

[amyl]

I’ve done lots of ob in “fluffy” populations - namely Indiana where the bmis mostly start at 45 and go up. I don’t think it’s ever really helped me and I’m pretty adept w the ultrasound. Developing “feel” which I am sure you have has served me much more often

 

[Planktonmd]

It's clunky and rarely helpful

 

[Justice4all]

very rare to guide toward midline as most of cases in lateral position under GA( peds) for the ultrafluffy patients. I think I ve used it once in last 5 years

 

[Twiggidy]

Anyone using?

Worth learning for the remainder of my OB anesthesia career? (maybe 5 years before I refuse to do it anymore 😀)

No and No

For me with large BMI patients I'm just upfront with the patient. "Ma'am, I'm going to be moving around a lot and if you feel sharp let me know and I'll give more local" I just find what I figure is midline and try to hit a bone, then I'll know I'm in the ball park. If I'm lucky I'll engage the space.

As others have said, doing enough "normals" for it to be helpful with difficult patients is such a waste that there's no real gain in learning it, especially if you're on the down slope of your OB career.

 

[narcusprince]

I have used the ultrasound on obese patients with scoliosis. These are challenging epidurals. Can I get the epidural without the ultrasound yes. Can it reduce my time to loss and reduce the passes I make with the epidural needle, yes.

 

[woopedazz]

I use it when re-siting a junior's dodgy epidural where I'm not sure if the LOR is epidural space or the 50+mL of local they've dumped just posterior to it. Gives you confidence to drive straight through that first pretender LOR.

 

[NoodleIncident]

No, but I’ve seen people use it for all of their total joint spinals. Slap a probe on, take a picture, set the probe aside, place the spinal in the skinny geriatric, then bill for US usage.

 

[nimbus]

I don’t do OB but it seems like it could be useful to avoid wet taps in very skinny moms with mushy ligaments.

 

[narcusprince]

No, but I’ve seen people use it for all of their total joint spinals. Slap a probe on, take a picture, set the probe aside, place the spinal in the skinny geriatric, then bill for US usage.

Them some greedy sumiches!