TY  - CHAP
M1  - Book, Section
TI  - Ultrasound Imaging of the Lumbar Spine for Central Neuraxial Blocks
A1  - Karmakar, Manoj K.
A1  - Soh, Edmund
A1  - Chee, Victor
A1  - Sheah, Kenneth
Y1  - 2018
N1  - 
T2  - Atlas of Sonoanatomy for Regional Anesthesia and Pain Medicine
AB  - Central  neuraxial  blocks  (CNBs),  which  include  spinal,  epidural,  and  combined  spinal  epidural  (CSE)  injections,  are  frequently  performed  in  the  lumbar  region  for  anesthesia  and  analgesia  and  for  managing  chronic  pain.1  Traditionally,  they  are  performed  using  a  combination  of  surface  anatomic  landmarks,  the  operator's  tactile  perception  of  “loss  of  resistance”  during  needle  advancement  through  the  ligamentum  flavum,  and/or  visualizing  the  efflux  of  cerebrospinal  fluid.  Anatomic  landmarks  (eg,  the  spinous  processes)  are  useful  but  they  are  not  always  easily  palpable  in  patients  with  edema,  obesity,2  underlying  spinal  deformity,  or  previous  back  surgery.  The  “Tuffier's  line,”  which  is  a  line  joining  the  highest  points  of  the  iliac  crests,  is  another  surface  anatomical  landmark  that  is  widely  used  to  estimate  the  location  of  the  L4  to  L5  interspace;  however,  the  correlation  is  inconsistent.3  Even  in  the  absence  of  spine  abnormalities,  estimation  of  a  specific  intervertebral  level  may  not  be  accurate  in  many  patients4,5  and  may  result  in  needle  placement  one  or  two  spinal  levels  higher  than  intended.4–7  This  inaccuracy  is  exaggerated  in  the  obese  and  in  the  upper  spinal  levels.4,6,8  Furthermore,  using  surface  anatomical  landmarks  alone,  it  is  not  possible  to  predict  the  ease  or  difficulty  of  needle  placement  prior  to  skin  puncture.  Unanticipated  technical  difficulty,  multiple  attempts  at  needle  placement,  and  failure  of  CNB  are  therefore  prevalent  in  clinical  practice.9,10  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/17
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1146854808
ER  -