Ultrasound-facilitated epidurals and spinals in obstetrics

Regional anesthesia is currently the gold standard of practice for pain control in obstetrics. Failures and complications of regional anesthesia can be related to many causes, one of the most important being the blind nature of such techniques. The practice of epidurals and spinals relies primarily on the palpation of anatomic landmarks that are not always easy to find. Ultrasound has recently been introduced into clinical anesthesia to facilitate lumbar spinals and epidurals. The use of preprocedure ultrasound imaging or, eventually, real-time ultrasound guidance should improve not only clinical practice, but also teaching. This article describes the techniques, challenges, and benefits related to the use of ultrasound in guiding lumbar spinals and epidurals.