Spinal Sonography for Ultrasound-Guided Lumbar Neuraxial Anesthesia

Neuraxial anesthesia is one of the few remaining forms of regional anesthesia that relies on palpation and tactile feedback techniques to facilitate catheterization into the epidural space. Over two decades ago, spine ultrasonography was demonstrated to provide reliable guidance for locating the epidural space. Compared to the palpation technique, preprocedural ultrasonography has been shown to result in fewer needle punctures and fewer traumatic procedures, particularly in patients with abnormal or distorted spine anatomy (e.g., scoliosis, obesity). Despite its utility, the ultrasound-guided neuraxial technique is still marginally used, even for patients with abnormal anatomy. Some experts attribute this to cost, a relatively high success rate without ultrasound, and a lack of technical expertise, which is often tied to formal education and regular practice. Several proponents of the ultrasound technique emphasize that proficiency requires practice on patients with normal spine anatomy, though this training may not be as challenging as once thought. This protocol was designed to help all providers learn the basics of lumbar spine anatomy and how to apply this knowledge clinically. Through a series of videos, we will provide step-by-step instructions for performing neuraxial ultrasonography and offer practical tips for troubleshooting in cases of difficult anatomy.