Related Experiment Video
Updated: Aug 16, 2026
Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia
Published on: January 31, 2025
Ultrasound-guided epidural catheter insertion in children
Hans-Jürgen Rapp1, A Folger, T Grau
1*Department of Anesthesiology and Intensive Care, University Hospital Mannheim and †Department of Anesthesiology University Hospital Heidelberg, Faculties of the Ruprecht-Karls-University, Heidelberg, Germany.
Insights
Ultrasound (US) enhances epidural catheter placement in children by clearly visualizing neuraxial structures and depth, improving procedural accuracy and safety for pediatric pain management.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging
- Pain Management
Background:
- Epidural catheters (EC) are crucial for pediatric pain relief but challenging to place due to small anatomy and general anesthesia.
- Accurate identification of neuraxial structures is vital to prevent complications during EC insertion.
Purpose of the Study:
- To investigate the utility of ultrasound (US) in identifying neuraxial structures during epidural catheter insertion in children.
- To assess the accuracy of US in determining the depth of epidural space and guiding catheter placement.
Main Methods:
- Ultrasound examination was performed in pediatric patients (ASA I-II) before epidural catheter insertion.
- A sterile kit facilitated US probe positioning for real-time visualization during catheter insertion.
- The loss of resistance technique was used concurrently with US guidance.
Main Results:
- Ultrasound clearly identified the epidural space, ligamentum flavum, and dural structures in all evaluated patients.
- A strong correlation (0.88) was found between US-estimated depth and the loss of resistance depth.
- Epidural catheters were visualized during insertion in a significant portion of patients, aided by US.
Conclusions:
- Ultrasound is an effective tool for visualizing critical neuraxial anatomy in pediatric patients.
- US improves the identification of epidural space depth and facilitates accurate catheter placement.
- This technique enhances the safety and precision of epidural catheterization in infants and children.
Unlabelled:
Epidural catheters (EC) are often used in pediatric patients for intraoperative and postoperative pain relief. The small anatomical structures and catheter insertion under general anesthesia make it more difficult to perform EC and to prevent damage. In this study we investigated the use of ultrasound (US) in detecting neuraxial structures during insertion and placement of EC in children. ASA I-II children scheduled for elective surgery under combined general and epidural anesthesia were studied. Patients received balanced anesthesia using sevoflurane, opioids and rocuronium. Before EC insertion US examination in a lateral position was done to visualize and identify neuraxial structures. Quality of visualization and site and depth of structures were recorded. Using a sterile kit to hold the US probe in position and enable the visualization of the neuraxial structures, an epidural cannula was inserted, using the loss of resistance technique, as the EC passed under US control to the desired level. Of 25 children, 23 were evaluated. Epidural space, ligamentum flavum, and dural structures were clearly identified and the depth to skin level estimated in all patients. Loss of resistance was visualized in all patients with a lumbar epidural approach. Correlation of US measured depth and depth of loss of resistance was 0.88. In eight of 23 patients EC could be visualized during insertion and in 11 others it could be visualized with additional US planes. US is an excellent tool to identify neuraxial structures in both infants and children. The size and the incomplete ossification of the vertebra allow exact visualization and localization of the depth of the epidural space, the loss of resistance, and all relevant neuraxial structures.
Implications:
Epidural catheters in children are mostly inserted under sedation or general anesthesia. This study showed that the use of ultrasound could help visualize all relevant neuraxial structures and their site and depth from the skin.
