Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5900-5908
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5900
Preprocedure ultrasound imaging combined with palpation technique in epidural labor analgesia
Jian-Ping Wu, Yuan-Zhang Tang, Liang-Liang He, Wen-Xing Zhao, Jian-Xiong An, Jia-Xiang Ni
Jian-Ping Wu, Yuan-Zhang Tang, Liang-Liang He, Jia-Xiang Ni, Department of Pain Management, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
Jian-Ping Wu, Wen-Xing Zhao, Jian-Xiong An, Department of Anesthesiology and Pain Medicine, Aviation General Hospital of China Medical University, Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China
Author contributions: Wu JP conceived this study, collected the data, analyzed the formal, and drafted the manuscript; Tang YZ, He LL, and Zhao WX contributed to the investigation, methodology and writing, reviewing, and editing of the manuscript; An JX contributed to the project administration and writing, reviewing, and editing of the manuscript; Ni JX supervised the study and contributed to the project administration, resources, software and writing, reviewing, and editing of the manuscript; All authors proofread and approved the revised manuscript.
Institutional review board statement: This study was reviewed and approved by the Aviation General Hospital of China Medical University Institutional Review Board.
Clinical trial registration statement: The study is registered at Chinese Clinical Trial Registry, using identifier ChiCTR1800014782.
Informed consent statement: Informed written consent was obtained from every parturient.
Conflict-of-interest statement: No conflict-of-interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia-Xiang Ni, MD, Chief Doctor, Director, Professor, Department of Pain Management, Xuanwu Hospital of Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. nijiaxiang@263.net
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: April 14, 2021
Revised: April 19, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: July 26, 2021
Abstract
BACKGROUND

For parturients with paroxysmal uterine contraction pain, rapid analgesia is needed. We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor, and evaluated the usefulness of this technique in epidural labor analgesia.

AIM

To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.

METHODS

In this prospective randomized observational study, 72 parturients were assigned to two groups (combined or palpation group). The target interspace of all parturients was first identified by the palpation technique. Then in the combined group, preprocedure ultrasound imaging was used before epidural puncture. In the palpation group, only the traditional anatomical landmarks technique (palpation technique) was performed. The primary outcome was total duration of the epidural procedure (for the ultrasound group, the duration of the preprocedure ultrasound imaging was included). The secondary outcomes were the number of skin punctures, the success rate at first needle pass, the number of needle passes, the depth from the skin to epidural space, and the complications of the procedure.

RESULTS

Total duration of the epidural procedure was similar between the two groups (406.5 ± 92.15 s in the combined group and 380.03 ± 128.2 s in the palpation group; P = 0.318). A significant improvement was demonstrated for epidural puncture and catheterization in the combined group. The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group (P = 0.001). The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group (P = 0.398). The success rate at first needle pass was 88.89% in the combined group and 66.67% in the palpation group (P = 0.045).

CONCLUSION

This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique, which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

Keywords: Preprocedure ultrasound imaging, Epidural puncture, Epidural catheterization, Palpation technique, Labor analgesia

Core Tip: This is the first study of preprocedure ultrasound imaging combined with the palpation technique in epidural labor analgesia. This combined technique increases the first-pass success rate of epidural catheterization but does not increase the total procedural time in labor analgesia.