Grant: Operating Grant

The majority of pregnant Canadian women have epidural anesthesia (an "epidural") to ease the pain of labour and delivery. Currently, this is a challenging procedure for the anesthesiologist and it takes approximately one hundred patients for a resident to train and achieve competency. This is a long training curve because the insertion of an epidural needle into the spine requires a delicate sense of touch to pick the puncture site above the target epidural site and then push the needle until it enters the epidural space, without overshooting and entering the spinal cord. Even for experienced anesthesiologists, the presence of obesity and spinal deformities can still make this a challenging procedure. Complications include accidental puncture of the membrane around the spinal cord, headaches, nerve damage and very rarely paralysis. The rate of these complications plus the failure to achieve sufficient anesthesia is estimated to be 6-25%. This is due in large part to incorrect needle placement. We propose to use a new 3D ultrasound technique to make epidural needle placement more accurate. In particular, we will develop smart rendering methods of the 3D ultrasound data to clearly show the target epidural space and the needle. We will also make it easy to operate by automatically showing the ideal ultrasound image of the target. This will be implemented on standard ultrasound machines are the now available in most anesthesiology departments. The outcome of this research will be a working 3D ultrasound system that works reliably on a wide range of patients.