• Yong Seon Choi, Jaewon Jang, Ha Yan Kim, Bora Lee, Eun Jung Kim, Hei Jin Yoon, Jongyun Lee, and Hye Jin Kim.
• Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of).
• Reg Anesth Pain Med. 2023 Dec 30.

IntroductionThe present study aimed to compare the correlation and agreement of epidural depth estimation using ultrasound in the paramedian sagittal oblique (PSO) versus the transverse median (TM) plane relative to the actual epidural depth observed during midline epidural punctures in children with scoliosis.MethodsIn this prospective observational study, we enrolled 55 children aged 3-14 years with thoracolumbar scoliosis (Cobb angle >10°) requesting postoperative epidural analgesia. Ultrasound imaging was performed to estimate the distance from the skin to the epidural space in the bilateral PSO and TM planes. An anesthesiologist performed midline epidural puncture and measured the actual epidural depth from the skin to the epidural space. The correlation and degree of agreement between the ultrasound-estimated and actual epidural depths were investigated using Pearson's and concordance correlation coefficients. The image quality of the ligamentum flavum and posterior dura mater was compared.ResultsIn the PSO view, where the larger of the two measurements from both sides was used, both Pearson's and concordance correlation coefficients for comparing the actual epidural and ultrasound-estimated depths were significantly higher than those in the TM view (0.964 vs 0.930, p value=0.002; 0.952 vs 0.892, p value=0.004, respectively). The ligamentum flavum-posterior dura mater unit was more easily distinguished in the PSO view than in the TM view (72.7% vs 38.2%, p value<0.001).ConclusionsThe PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization.Trial Registration NumberNCT04877964.© American Society of Regional Anesthesia & Pain Medicine 2023. No commercial re-use. See rights and permissions. Published by BMJ.

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