Use of Ultrasound Guidance to Assist With Labor Epidural Placement in Patients With a BMI ≥40

Use of Ultrasound Guidance to Assist With Labor Epidural Placement in Patients With a BMI ≥40

Placement of labor epidurals is a very common daily practice in obstetrical anesthesia. Currently, these epidurals are placed based upon palpation of landmarks to determine midline and the correct spinal level for placement. Palpation of these landmarks can be difficult, however, particularly in morbidly obese patients who have significant amounts of soft tissue overlying them. This study seeks to use ultrasound guidance to examine the spine prior to epidural placement, and see what effects this has compared to palpation alone with respect to procedure time, number of attempts, success rate in the first attempt, failure rate, complication rate, patient anxiety levels, and patient satisfaction levels.

Inclusion Criteria:

• Current (pregnant) BMI ≥ 40
• Age ≥ 18
• ASA score of 3 or less
• Full term pregnancy (37 weeks gestational age or greater)

Exclusion Criteria:

• Known scoliosis
• Known contraindications to neuraxial blockade
• Intrauterine fetal demise or non-viable fetus.