Ultrasound-Guided L5-S1 Placement of Labor Epidurals Doesn’t Improve Dermatomal Blockade

February 14, 2017

A study that compared epidurals placed in the L5-S1 interspace and those placed in the most clinically accessible lumbar interspace cephalad found no significant differences in efficacy. The mean number of dermatomes blocked, number of interventions required to achieve adequate analgesia, and pain scores following epidural placement and at delivery were all similar in the L5-S1 and control groups.  However, the study did demonstrate the utility of ultrasound in planning epidural trajectory and placement, according to researcher Omar Malas, MD.  “Anecdotally, we noticed that the benefit that we may be seeing from sacral sparing in the L5-S1 group may be canceled out by lumbar sparing, particularly in patients who are primigravid or who have longer labor,” said Dr. Malas, an anesthesiology resident at the University of Michigan, in Ann Arbor.  The findings were reported at the 2016 annual meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA).