Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942010000100002
Brazilian Journal of Anesthesiology
Scientific Article

Uso do ultrassom para determinação do nível de punção lombar em gestantes

Use of the ultrasound to determine the level of lumbar puncture in pregnant women

Giovani de Figueiredo Locks; Maria Cristina Simões de Almeida; Amanda Amaro Pereira

http://dx.doi.org/10.1590/S0034-70942010000100002 Braz J Anesthesiol, vol.60, n1, p.13-19, 2010
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Resumo

JUSTIFICATIVA E OBJETIVOS: Para determinar o nível vertebral para punção lombar, utiliza-se uma linha imaginária que une as cristas ilíacas. Essa linha cruza a coluna vertebral no nível L4 ou no espaço L4-L5. Essa referência anatômica pode ser inexata em grande proporção de pacientes. Este estudo teve como objetivo determinar se há diferença na determinação do espaço vertebral L3-L4 pelo exame físico quando comparado ao ultrassom em gestantes obesas e não obesas. MÉTODO: Foram estudadas pacientes adultas submetidas à cesariana eletiva sob raquianestesia. As pacientes foram analisadas em dois grupos: obesas e não obesas. Com a paciente na posição sentada, foi determinado pelo exame físico o espaço vertebral L3-L4. Em seguida, foi executada a ultrassonografia da região lombar. Houve a identificação do osso sacro e o transdutor foi dirigido em direção cranial para identificar os processos espinhosos das vértebras lombares. Foi registrado qual nível vertebral havia sido estimado clinicamente como L3-L4. RESULTADOS: Foram incluídas 90 pacientes, sendo 43 não obesas e 47 obesas. Em todas as pacientes, foi possível a determinação dos espaços vertebrais lombares por meio da ultrassonografia. Os espaços vertebrais identificados como L3-L4 ao exame físico corresponderam aos estimados como L3-L4 pelo ultrassom em 53% e 49% nos grupos não obesas e obesas, respectivamente. Não houve diferença significativa entre os grupos. CONCLUSÕES: As percentagens de acerto na identificação do espaço vertebral L3-L4 em gestantes obesas e não obesas são baixas. A ultrassonografia da coluna vertebral pode reduzir o erro de determinação do espaço vertebral L3-L4 em gestantes obesas e não obesas.

Palavras-chave

EQUIPAMENTOS, GRAVIDEZ, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: An imaginary line connecting both iliac crests is used to determine the vertebral level for lumbar puncture. This line crosses the spine at the level of L4 or the L4-L5 space. This anatomical reference can be inaccurate in a large proportion of patients. The objective of the present study was to determine whether the identification of the L3-L4 space by the physical exam differs from that of the ultrasound in obese and non-obese pregnant women. METHODS: Adult patients undergoing elective cesarean sections under spinal block participated in this study. Patients were divided in two groups: obese and non-obese. The L3-L4 space was determined by physical exam with the patient in the sitting position. This was followed by a lumbar ultrasound. After the sacrum was identified, the transducer was directed in the cephalad direction to identify the spinous processes of the lumbar vertebrae. The clinically estimated L3-L4 level was recorded. RESULTS: Ninety patients, 43 obese and 47 non-obese, were included in this study. Lumbar intervertebral spaces were identified by ultrasound in all patients. The L3-L4 space clinically identified corresponded to the ultrasound identification in 53% and 49% of the cases in the non-obese and obese groups, respectively. There was no significant difference between groups. CONCLUSIONS: The L3-L4 space is correctly identified in a low percentage of obese and non-obese pregnant women. Spinal ultrasound can reduce the incidence of mistaken identification of the L3-L4 space in obese and non-obese pregnant women.

Keywords

ANESTHETIC TECHNIQUE, Regional, EQUIPMENT, PREGNANCY

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