• Lucas Resque Porto, Raymond Tang, Andrew Sawka, Victoria Lessoway, Emran Mohammad Abu Anas, Delaram Behnami, Purang Abolmaesumi, and Robert Rohling.
• Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada. Electronic address: lucasporto@ece.ubc.ca.
• Ultrasound Med Biol. 2019 Jan 1; 45 (1): 255-263.

AbstractPatient positioning and needle puncture site are important for lumbar neuraxial anesthesia. We sought to identify optimal patient positioning and puncture sites with a novel ultrasound registration. We registered a statistical model to volumetric ultrasound data acquired from volunteers (n = 10) in three positions: (i) prone; (ii) seated with thoracic and lumbar flexion; and (iii) seated as in position ii, with a 10° dorsal tilt. We determined injection target size and penetration success by simulating lumbar injections on validated registered models. Injection window and target area sizes in seated positions were significantly larger than those in prone positions by 65% in L2-3 and 130% in L3-4; a 10° tilt had no significant effect on target sizes between seated positions. In agreement with computed tomography studies, simulated L2-3 and L3-4 injections had the highest success at the 50% and 75% midline puncture sites, respectively, measured from superior to inferior spinous process. We conclude that our registration to ultrasound technique is a potential tool for tolerable determination of puncture site success in vivo.Copyright © 2018 Elsevier Ltd. All rights reserved.

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