Quote from CCRN_CSC_0710
I'm not far in my program (graduate in 2019) but I'll have a lot of questions. One that came up last week though is epidural placement in obese patients. Is there any ultrasound technology or something for spirals/epidurals when it's not possible to palpate bony prominences?
Yes, there is, and there are folks that use it and promote it, but I can tell you that I've never met anyone that uses u/s for that with any regularity at all. Not being able to palpate landmarks is not an impediment to placing a neuraxial block for a routine case (ie, elective surgery or labor epidural). Now, chronic pain management is another story that presents unique challenges, but that isn't what we're talking about here. It's just the typical obese patient for an elective procedure.
Being able to see and palpate everything is no guarantee of an easy block either The largest patient I ever put an epidural in was around 560 pounds and needed a lot of help staying still. That was with a normal length touhy needle.
More than u/s, excellent positioning, lining up the base of the neck with the top of where the gluteal cleft should be and simply asking the patient where he feels the needle going and redirecting based on that is the most efficient way of putting these blocks in, imo.
Another caveat would be to go a little higher for placement in someone you desired a lumbar epidural, around T11-12.
One last trick that works for me...an epidural needle is far more maneuverable than a spinal needle, so on occasion, I'll find the epidural space with that and use it for an introducer for a long spinal needle for a spinal anesthetic.