Utility of Ultrasound in Identification of Midline and Placement of Epidural in Severely Obese Parturients
Condition: Epidural Anesthesia; Spinal Ultrasound; Obesity
Study type: Interventional

Summary: 
      This study will address the utility of ultrasound in the placement of an epidural catheter in
      severely obese parturients. Identification of midline can often be difficult using the
      standard method of palpation in obese patients. The Investigator will determine if the use of
      ultrasound decreases the amount of time and number of attempts required to place the
      epidural.
    

Detailed description: 
      The use of ultrasound has expanded into many areas of medicine including the identification
      of bony landmarks to facilitate epidural placement in obstetric anesthesia. Using ultrasound
      for epidural placement has become popular over the last decade with several studies being
      published on the topic. The likely increase in popularity for ultrasound use in the obstetric
      population is the need to more reliably locate bony landmarks as the traditional palpation
      technique has been shown to be an inaccurate way to accomplish this. Given the fact that the
      long-taught palpation technique can be inaccurate and studies have validated the use of
      ultrasound for epidural placement, ultrasound technique is routinely taught by the obstetric
      anesthesiologists to the anesthesiology residents at the University of Alabama at Birmingham
      (UAB). Also, since both techniques are considered standard practice at UAB, anesthesia
      providers (residents, fellows, and faculty) are free to choose either technique to locate
      bony structures of the back prior to epidural placement. Since no current study has
      specifically addressed its use in the obese pregnant patient, the investigators would like to
      validate its use in this population.

      In this study, investigators will evaluate the use of ultrasound in the obese population to
      determine if its use will decrease the time it takes to place the epidural and number of
      attempts required when compared to the traditional palpation technique. The study will also
      determine the success rate of epidural placement in both the palpation and ultrasound groups.
    

Intervention name(s): Palpation; Ultrasound
Intervention type(s): Procedure; Device
Intervention description(s): Traditional epidural methods used for the identification of the midline using palpation prior to procedure; Lumbar spinal ultrasound performed for identification of the midline prior to procedure.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Upon enrollment into the study, participants will be randomized 1:1 to either ultrasound or palpation. Randomization will be performed via random drawing: the provider will randomly select a card assigning the method of midline identification (i.e., ultrasound or palpation). Anesthesia providers will not be randomized. Any qualified provider available to place the epidural will be the person to perform the procedure.
Masking: None (Open Label)
Primary purpose: Treatment