Determining the tuffier's line by ultrasound in pregnant and non-pregnant women patients

DETERMINING THE TUFFIER'S LINE BY ULTRASOUND IN PREGNANT AND NON-PREGNANT WOMEN PATIENTS Dr. Bahar ŞEKER Recidency Thesis, Anesthesiology and Reanimation Thesis Advisor: Prof. Dr. Lütfiye PİRBUDAK July - 2018, 62 Pages Aim and Background: We aimed to compare palpation technique and ultrasound technique to determine the correct vertebral level in pregnant and non-pregnant women. Material and Method: 135 women were included to this prospective study. Patients were divided into two groups as pregnant (n=75) and non-pregnant (n=60) groups. In order to verify the accuracy of Tuffier's line obtained by palpation, ultrasound evaluation was performed to both groups in lateral decubitus position. Demographic characteristics, time to obtain the Tuffier's line with palpation and ultrasound and detected vertebral levels were recorded. Results: The demographic characteristics were similar between the groups. Time to determine Tuffier's line vertebral level by palpation was 5 ± 1.63 seconds in pregnant group and 4.43 ± 1.45 seconds in non-pregnant group with a statistically significant difference (p=0.037). Time to determine the Tuffier's line vertebral level by ultrasound was 46.81 ± 14.11 seconds in pregnant group and 43.52 ± 10.55 seconds in non-pregnant group. The difference between the groups was not significant. Tuffier's line which determined by palpation was at L4 level in %41.3 of pregnant group and %36.7 of non-pregnant group. L4-L5 intervertebral space was detected by palpation in 58.7% of pregnant and in 63.3% of non-pregnant women. Estimated vertebral level as L4 with palpation was found as L2 in %9.7, L3 in %9.7 and, L4 as %80.6 of pregnant and as L4 in %100 of non-pregnant women with ultrasound. Estimated vertebral interspace as L4-L5 was found as L2-L3 in %6.8, L3-L4 in %70.4, L4-L5 in %22.5 of pregnant; L2-L3 in %5, L3-L4 in %58, L4-L5 in %37 of non-pregnant women. Vertebral levels determined by both techniques in both groups were consistent with 35 (%46.6) patients in pregnant group and 36 (%60) patients. Discussion and Conclusion: We determined that regardless of pregnancy and demographic characteristics Tuffier'line does not indicate the accurate vertebral level. We obtained that ultrasound technique is more reliable than palpation in this manner. We believe that by detecting the needle insertion point with lumbar ultrasound before the procedure, spinal cord injury can be avoided in patients who will undergone to central neuraxial block. Keywords: Central blocks in pregnant, Lumbar ultrasonography, spinal anesthesia, Tuffier's line, vertebral level