Ultrasound for Epidurals

  • Position as for central neuraxial insertion

  • Use curved probe

  • Identify sacrum and appropriate interspace in paramedian sagittal oblique (PSO) plane

  • Anterior complex = vertebral body, posterior longitudinal ligament and anterior dura

  • Posterior complex = ligamentum flavum, epidural space and posterior dura

  • Mark the horizontal evel

  • Switch to transverse plane and identify "bat-wing" sign

  • Mark midline

  • Measure depth to LF using calipers

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