Identification of L3-L4 Interspace in Parturients

Study Overview
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Brief Summary
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The investigators hypothesize that teaching ultrasound sonoanatomy to identify the L3-L4 interspace will improve resident's long term skill to correctly identify the interspace as compared to palpation alone.

Detailed Description
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This will be an observational education based study to improve anesthesiology resident's ability to correctly identify the L3-L4 interspace. Residents who agree to participate in the study will be trained using ultrasound to identify the L3-L4 interspace during their rotation on the obstetric anesthesia service. Training will include using the ultrasound to correlate the surface palpation with the underlying structures. This will be supplemented with teaching videos and literature. The training will be performed for the first three weeks of the four week rotation. After undergoing this training program, during the fourth week of the rotation, the residents will be asked to perform palpation identification of the L3-L4 interspace on parturients. Ultrasound will be used to assess the accuracy of the identified level. These assessments will repeated at six and 12 months to assess whether the skill has been retained.

Official Title
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Identification of L3-L4 Interspace in Parturients

Conditions
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Healthy

Intervention / Treatment
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* Other: Education


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: term gestation (at least 38 weeks gestation) Exclusion Criteria: Prior back surgery Previously diagnosed skeletal deformities such as scoliosis BMI greater than 40 Height less than 60 inches Patient discomfort requiring immediate analgesia

Ages Eligible for Study
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Minimum Age: 12 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ultrasound education<br>Training in the use of ultrasound to identify the L3-L4 interspace | Other: Education<br>* Educational intervention in the use of ultrasound to identify landmarks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Accuracy measured as percentage of cases where the L3-4 vertebral interspace is identified correctly | Percentage of cases where the L3-4 vertebral interspace is identified correctly | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Durability measured as percentage of cases where the L3-4 vertebral interspace is identified correctly | percentage of cases where the L3-4 interspace is identified correctly at 6 months and again at 12 months | 6 months and 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ultrasound, Palpation, Analgesia, Epidural