The Korean Journal of Pain

  • 제25권2호
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  • Pages.99-104
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  • 2012
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  • 2005-9159(pISSN)
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  • 2093-0569(eISSN)
대한통증학회 (The Korean Pain Society)
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Ultrasonographic Measurement of the Ligamentum Flavum Depth : Is It a Reliable Method to Distinguish True and False Loss of Resistance?

  • Pak, Michael Hae-Jin (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Lee, Won-Hyung (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Ko, Young-Kwon (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • So, Sang-Young (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Kim, Hyun-Joong (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital)
  • 투고 : 2011.11.07
  • 심사 : 2012.01.11
  • 발행 : 2012.04.01
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초록

Background: Previous studies have shown that if performed without radiographic guidance, the loss of resistance (LOR) technique can result in inaccurate needle placement in up to 30% of lumbar epidural blocks. To date, no study has shown the efficacy of measuring the depth of the posterior complex (ligamentum flavum, epidural space, and posterior dura) ultrasonographically to distinguish true and false LOR. Methods: 40 cervical epidural blocks were performed using the LOR technique and confirmed by epidurograms. Transverse ultrasound images of the C6/7 area were taken before each cervical epidural block, and the distances from the skin to the posterior complex, transverse process, and supraspinous ligament were measured on each ultrasound view. The number of LOR attempts was counted, and the depth of each LOR was measured with a standard ruler. Correlation of false and true positive LOR depth with ultrasonographically measured depth was also statistically analyzed. Results: 76.5% of all cases (26 out of 34) showed false positive LOR. Concordance correlation coefficients between the measured distances on ultrasound (skin to ligamentum flavum) and actual needle depth were 0.8285 on true LOR. Depth of the true positive LOR correlated with height and weight, with a mean of $5.64{\pm}1.06cm$, while the mean depth of the false positive LOR was $4.08{\pm}1.00cm$. Conclusions: Ultrasonographic measurement of the ligamentum flavum depth (or posterior complex) preceding cervical epidural block is beneficial in excluding false LOR and increasing success rates of cervical epidural blocks.

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참고문헌

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  3. Prediction of midline depth from skin to cervical epidural space by lateral cervical spine X-ray vol.12, pp.1, 2012, https://doi.org/10.17085/apm.2017.12.1.68
  4. Lumbar epidural depth using transverse ultrasound scan and its correlation with loss of resistance technique: A prospective observational study in Indian population vol.12, pp.2, 2012, https://doi.org/10.4103/sja.sja_679_17