Different Type Ultrasound Guided Epidural Block Methods

Study Overview
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Brief Summary
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The nerve blocks applied with ultrasonography are used for pain and operation after many operations today. Applications with ultrasonography shorten the processing time, reduce the amount of local anesthetic used and lead to fewer complications. However, the use of ultrasonography is not so common in neuraxial regional anesthesia applications. In the literature, epidural applications accompanied by ultrasonography were applied with different approaches.

Detailed Description
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In this study the investigators will used the two different ultrasound -guided epidural block approach . Paramedian sagittal oblique and Transverse interlaminar. The investigators will used this two technique in epidural catheter placement using the real-time ultrasound.

Official Title
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Evaluation of Different Type Ultrasound Guided Epidural Block Methods ; Paramedian Sagittal and Transverse Interlaminar View

Conditions
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Epidural Anesthesia, Ultrasound

Intervention / Treatment
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* Other: Epidural block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients who were in the American Society of Anesthesiologists (ASA) I-III class Patients whom need medical epidural anesthesia Patients with consent to participate in the study Exclusion Criteria: Patients with a known history of back surgery Bleeding diathesis disorder Allergy to local anesthetics Patient refusal

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: Conventional Epidural application<br>Epidural catheter insertions with conventional (anatomical landmarks use) method | Other: Epidural block<br>* Epidural catheter insertions<br>|
| Active Comparator: Paramedian sagittal application<br>Epidural catheter insertions with real time ultrasound guided Paramedian sagittal approach | Other: Epidural block<br>* Epidural catheter insertions<br>|
| Active Comparator: Transverse Interlaminar application<br>Epidural catheter insertions with real time ultrasound guided Transverse Interlaminar approach | Other: Epidural block<br>* Epidural catheter insertions<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of needle routing | number of needle redirects forming successful block | 20 minutes | 
| Epidural catheter placement time | time (minutes) until the epidural catheter is inserted | 20 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Epidural igne visibility degree | 4 = Excellent visibility, 3 = Medium visibility, 2 = Weak visibility 1 = No visibility using a 4-point Likert scale by the practitioner | 20 minutes | 
| Difficulty of catheter placement | Assessed by the Practitioner using a 10-point scale, 0: easiest, 10: hardest) | 30 minutes | 
| distance measurement of neuraxial structures | Anterior and posterior complex distance measured during epidural administration. Distance from skin to anterior aspect of ligament flavum (cm) Distance from skin to posterior dura (cm) | 30 minutes | 
| Patient position | Patient position during epidural placement Sitting Lateral | 20 minutes |