It seems ultrasound really can be used for anything. Epidurals in small children are hard to place, and have to be done while the child is anaesthetised. So it’s hard to say if you placed the catheter correctly for subsequent pain management. In this article, epidural catheters during cardiac surgery was placed and verified using the TEE probe that was already in place for assessing the child’s peroperative cardiac function.

We have previously looked at the future possibility of placing an epidural needle with the aide of an ultrasound probe in the needle, but this article uses available technology applied in a novel way by a center in Iowa. By rotating the TEE probe towards the spine, and moving it up or down they could get a view between two vertebraes, through the intervertebral disc and get an excellent and detailed view of the spinal chord and all the structures surrounding it.

The article is a case report of 12 children between 16 days and 4 years of age, weighing between 3.3 and 23.5 kg. So, mostly tiny creatures, set for cardiac surgery. Before vertebral ossification (around 6 months of age) you might get a view with transcutaneous ultrasound, but older than that, TEE is the only way to visualise these structures.

The epidural needle was placed with conventional LOR technique (but see article at bottom for reference of epidural needle placement using ultrasound), and the epidural catheter insertion and placement was guided by TEE.

The US image shows the spinal chord, and the epidural space relvealed after injecting saline throught the catheter.

The epidural catheter is highly echogenic, so it lights up in the images, making it easy to assess placement and the position of the tip of the catheter. They also evaluated spread of injections through the catheter, and the article contains a fascinating film clip showing a catheter moving up the epidural space, and a saline dose expanding the epidural space. A quite specialised procedure in a selective population, but still an interesting report and nice to see docs pushing the limits and finding new uses for ultrasound in daily work. Read the full article here:

Transesophageal Echocardiography: A Novel Technique for Guidance and Placement of an Epidural Catheter in Infants, Anesthesiology, January 2013.

For ultrasound guidance of placing the actual epidural needle, there’s an article from 2006 describing the use of transcutaneous ultrasound for epidural placement in children under 6 months of age. Certainly an advanced technique: they find ultrasound to be a great tool, but not surprisingly, only if you’re very experienced both with ultrasound and placing epidurals in small children. The article is free full text and well worth a read if you’re into paediatrics and ultrasound:

Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique, British Journal of Anaesthesia, 2006.

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  1. dr brian makamure says:

    Now this is medicine as i always envisaged it.innovative and constantly pushing the barriers further and further by using available tools and knowledge to do new things.believe its called improvisation.KUDOS TO YOU GUYS.

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