• T Grau, R W Leipold, J Horter, R Conradi, E O Martin, and J Motsch.
• Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany. thomas_grau@med.uni-heidelberg.de
• J Clin Anesth. 2001 May 1;13(3):213-7.

Study ObjectiveTo establish a useful ultrasonic approach to the epidural space so as to optimize pre-puncture diagnostics.DesignProspective study.SettingUniversity clinic.Patients60 participants (19 to 34 years of age), 40 healthy volunteers (20 male, 20 female) and 20 parturients.InterventionsUltrasound scanning of the lumbar spine was performed at the L(3)-L(4) vertebral interspace. Three ultrasound planes were employed: the transverse, median, and paramedian longitudinal approaches.MeasurementsWe compared the width of the ultrasound-permeable area in the median and paramedian planes and assessed the visibility of the epidural space and its surrounding structures.Main ResultsIn the paramedian plane, the permeable window was larger (p < 0.001) than in the median approach. The visibility of the ligamentum flavum (p < 0.0001), dura mater (p < 0.0001), and cauda equina (p < 0.0001) was significantly higher. Pulsation of epidural vessels could be observed more frequently (p < 0.0001) in the paramedian plane.ConclusionsThe longitudinal paramedian plane provided information about the epidural space depth in excellent imaging quality. The additional information might be beneficial in epidural anesthesia and in other clinical specialties (e.g., neurosurgery, trauma care).

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