A Simple Alternative Technique for the Placement of a Successful Neuraxial Block
•Neuraxial blocks are routinely performed either using traditional landmark techniques or under ultrasound guidance.
•4% of failed blocks(17-32%) are attributed to improper clinical techniques and technical difficulties in ascertaining the midline, leading to multiple attempts at placement, increased difficulty for access to the spaces or increasing patient discomfort.
•We describe an alternative technique by marking a point on the lower back approximately 13 centimetres from the top of the intergluteal cleft as reference.
•In the pursuit of ascertaining the midline, we found that the using the sheath with the intergluteal cleft as reference, helped in identifying a point that resulted in successful neuraxial blocks in a multitude of cases
•This sterile sheath measures 13.2 cm in length. The other alternative would be to use a sterile tape or scale to mark this point.
•The gluteal cleft though subjective like the traditional landmark palpation technique was a reasonable, non-invasive and simple guide.
•This tool can be used in patients with good palpable landmarks as well in those with obscured bony landmarks. It can be used freely, knowing that the point is safely below the L3 vertebra ensuring that we are below the anatomical level at which the spinal cord ends in adults. The only exclusion for the use of this technique is deformed spines.
•This technique is an easy and simple method for successful placement of neuraxial technique.
•Further comparative and objective studies are required to improvise this technique for routine use.