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Abstract
Introduction The 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.
Methods In 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.
Results In 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).
Conclusions The PSO view can be a reliable guide to facilitate epidural puncture in children with scoliosis with better visualization.
Trial registration number NCT04877964.
- Ultrasonography
- Pediatrics
- analgesia
Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author.
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Data availability statement
Data are available upon reasonable request. The data that support the findings of this study are available on request from the corresponding author.
Footnotes
Contributors YSC conceptualized and designed the study, collected and analyzed the data, and wrote the original draft of the manuscript. JJ: This author helped collect, analyze, and interpret data. HYK: This author analyzed and interpreted data and wrote the manuscript. BL: This author helped collect, analyze, and interpret data. EJK: This author analyzed and interpreted data. HJY: This author helped collect, and analyze data. JL: This author helped collect, and analyze data. HJK conceptualized and designed the study, collected and analyzed the data, and reviewed and edited the manuscript. HJK act as guarantor for the overall content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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