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Original Research

Open Access

Real-time ultrasound-guided vs. anatomical landmark-guided paramedian epidural anesthesia in overweight parturients undergoing analgesic labor: a randomized controlled trial

  • Jindi Jiang1
  • Yujie Xu1
  • Mingfeng He1

1Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, Jiangsu, China

DOI: 10.22514/sv.2021.218 Vol.17,Issue 6,November 2021 pp.66-73

Submitted: 01 August 2021 Accepted: 28 September 2021

Published: 08 November 2021

*Corresponding Author(s): Mingfeng He E-mail:


We evaluated whether real-time ultrasound-guided epidural block is more suitable for overweight parturients undergoing analgesic labor than traditional palpation positioning. Sixty overweight at-term pregnant women (body mass index ≥30 kg/m2) with singleton pregnancy, prepared for vaginal delivery with epidural analgesia, were randomly allocated into two groups. The parturients in the anatomical landmark catheterization group received paramedian epidural anesthesia using the anatomical landmark-guided technique, while real-time ultrasound-guided positioning was performed in the ultrasound-guided-catheterization group. Total procedure duration, time to identify the puncture site and perform the puncture, first attempt success rate, number of attempts, number of needle-redirections, intervertebral-space-change rate, satisfaction score, and complications were compared between the groups. Procedure duration and time to identify the puncture site were significantly shorter in the anatomical landmark catheterization group (440.1 ± 97.2 s vs. 521.9 ± 68.4 s, p < 0.001 and 24.9 ± 13.6 s vs. 112.2 ± 15.6 s, p < 0.001, respectively). There was no significant difference in the time to perform the puncture (385.3 ± 89.7 s vs. 365.1 ± 73.0 s, p = 0.341). The first attempt success rate was lower while the number of attempts and number of needle-redirections were higher in the anatomical landmark catheterization group (p < 0.05). The intervertebral-space-change rate was similar across the groups. Satisfaction was significantly lower in the ultrasound-guided catheterization group (p = 0.009). Complication occurrence, e.g., catheterization difficulty or bleeding during catheterization, dural puncture, and lower-back pain, was similar across the groups. Real-time ultrasound-guided paramedian epidural anesthesia improved the first attempt success rate and reduced the number of attempts and number of needle-redirections in overweight parturients undergoing analgesic labor. However, the longer total procedure duration and time to identify the puncture site might dissatisfy parturients.


Real-time ultrasound-guided; Paramedian epidural block; Overweight; Parturients; Analgesic labor

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Jindi Jiang,Yujie Xu,Mingfeng He. Real-time ultrasound-guided vs. anatomical landmark-guided paramedian epidural anesthesia in overweight parturients undergoing analgesic labor: a randomized controlled trial. Signa Vitae. 2021. 17(6);66-73.


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