Anestesia e Pesquisa Clínica
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Real-time Ultrasound Guided Epidural Catheter Placement in Morbidly Obese Parturients after Unsuccessful Conventional Attempts

Alexandre Gnaho, Clément Hoffmann, Sylvain Vico and Marc Emmanuel Gentili

Several studies have emphasized the usefulness of preprocedural Ultrasound (US) assessment of lumbar spine. Despite those helpful informations this procedure may remain challenging. This report evaluates the effectiveness of a Real Time US Guided Epidural Anesthesia (RTUGEA) in morbidly obese patients as usual loss of resistance technique combined with a preinsertion US assessment of lumbar spine had failed.

We performed successfully RTUGEA, in ten morbidly obese parturients. The epidural space was identified in all patients and one to three attempts was necessary to reach the epidural space. The tip of Tuohy needle was not visible in 4 cases. We were able to identify the catheter in one out of ten cases. None inadvertent dural puncture was recorded. Recovery from epidural analgesia was uneventful in all cases.

To our knowledge, there is no published data on real time ultrasound guided epidural anesthesia in morbidly obese patients. Our data support the usefulness in morbidly obese patients of a RTUGEA for lumbar access. Further extended and randomized study is needed to assess safety and efficacy of such procedure.