LAUSR

Difficult central neuraxial block (CNB) is a frequent problem that is encountered in operating rooms and may require multiple attempts or may sometimes result in procedural failure. In a study, it was observed that the first puncture success rate of a CNB was only 52.9%.[1] Though failed dural puncture was only 0.2% in this study, limiting the number of attempts is a prerequisite for safe neuraxial anaesthesia. In expected difficult spinal anaesthesia like in patients who are more than 35 years of age, are overweight, obese, have a history of difficult spinal puncture, have a spine deformity, have nonpalpable anatomical landmarks, and have narrow intervertebral space etc., good positioning and use of neuraxial ultrasonography (USG) are indicated.[2] Bogin and Stulin[3] first described the use of USG for determining the landmarks for lumbar puncture. Neuraxial USG identifies a given lumbar intervertebral space more accurately than the landmark technique; it provides excellent correlation between USG-measured depth and needle insertion depth to the epidural or intrathecal space and increases success and ease of performance.[4]