الفهرس 
Anatomy of the SpineOnly 14 pages are availabe for public view
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Abstract
Background: Lumbar epidural anesthesia is a common technique. Regional anesthesia, when possible provides better postoperative analgesia, is cost effective and avoids complications of general anesthesia. Aim of the Work: The aim of this study was to determine whether ultrasound imaging can reduce the risk of failed epidural catheterizations, when compared with standard landmark identification methods, and whether ultrasound imaging can reduce traumatic procedures, insertion attempts, and other complications. Patients and Methods: After approval of medical ethical committee of Faculty of Medicine, Ain Shams University, this randomized controlled clinical trial (RCT) was conducted on 75 patients, who were scheduled to undergo lower abdominal or lower limb surgeries under epidural anesthesia. Patients were divided into 3 equal groups; first (A) was the real-time ultrasound group, second (B) was pre procedure identification group and the third (C) was conventional landmark group. Results: There were statistically significant differences between groups regarding rate of failure of epidural anesthesia, with group (C) showing the highest failure rate, followed by pre procedure identification group (B) and the highest success rate was in the group (A). Also, there were highly significant differences regarding number of insertion attempts and number of needle redirections; the highest number of attempts and redirections was in the group (C) and the least number was in real-time ultrasound guided group (A). Patients’ most satisfaction; was obtained by using real-time ultrasound guided technique, followed by pre procedure identification technique and the least satisfaction was observed in conventional group. Conclusion: Real-time ultrasound imaging improved the ease of epidural catheter insertion, decreased the number of puncture attempts, number of needle redirection and improved patient satisfaction. We recommend to encourage acquiring this skill to be widely used in our daily practice especially in patients with difficult landmarks.