Handheld Ultrasound-assisted Versus Palpation-guided Labor Combined Spinal-epidural Analgesia

Handheld Ultrasound-assisted Versus Palpation-guided Labor Combined Spinal-epidural Analgesia: a Randomized Controlled Trial

Parturients who need combined spinal-epidural analgesia for labour analgesia are randomly assigned to two groups. For the handheld ultrasound-assisted technique group, ultrasound with 3D navigation function is used to determine the needle insertion point and the insertion angle. For the conventional palpation-guided technique group, the interspinous space is detected by palpation. Procedure time, the number of needle passes, the number of needle insertion attempts, success rate, and complications are compared.

This study aims to determine whether handheld ultrasound-guidance can reduce procedural time for labor combined spinal-epidural analgesia compared with conventional surface landmark-guided technique.

Participants will be received labor combined epidural-spinal analgesia using conventional landmark-guided technique

Ultrasound with 3D navigation function is used to determine the needle insertion point and the insertion angle.

Identifying time (time required to complete the preprocedural spinal ultrasound or the assessment by palpation) + Procedural duration (time from the initial Tuohy needle insertion through the skin to the completion of the threading of the epidural catheter)

time from the initial Tuohy needle insertion through the skin to the completion of the threading of the epidural catheter

Degree of pain during the procedure using 11-point verbal rating scale (0=no pain, 10=most pain imaginable)

Degree of discomfort during the procedure using 11-point verbal rating scale (0=no discomfort, 10=most discomfort imaginable)

The need to reinsert a new epidural catheter due to lack of sufficient analgesia within 2 hours of the primary insertion

Patient satisfaction with the quality of labor analgesia using 11-point verbal rating scale (0=very unsatisfied, 10=very satisfied)

Inclusion Criteria: - Adult parturients with ASA physical status classification I, II or III requiring a combined spinal-epidural for labor analgesia Exclusion Criteria: Contraindication to neuraxial anesthesia (local anesthetics hypersensitivity, coagulopathy, needle insertion site infection, etc.) Difficulty in communication Severe cardiac disease History of spine surgery Anatomical abnormality of the lumbar spine Age under 18

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