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Fig. 8. Surface marking to guide needle insertion. In the paramedian sagittal (PS) oblique view, each interspace (L3–L4 in this case) is centered in turn on the ultrasound screen (A ). A corresponding skin mark is made at the midpoint of the probe's long edge (B ). The probe is then turned 90 degrees to obtain the transverse interlaminar view (C ). The midline is centered on the ultrasound screen, and skin marks are made at the midpoint of the probe's long and short edges (D ). The intersection of these two marks provides an appropriate needle insertion point for a midline approach to the epidural or intrathecal space at that level. #PainManagement #POCUS #Spinal #Epidural #Anesthesia #Anatomy #Probe #Orientation #Marking #Parasagittal #Transverse
#PainManagement #Opioid #Misuse #RedFlags
Top left: probe is positioned in the longitudinal paramedian plane. Top right: sacrum is seen as a continuous hyperechoic line parallel to the skin, approximately 5 cm deep continuing as "cracks" (interspaces) alternating with "lumps" (lamina of different vertebrae). Bottom: close up at a lumbar "crack" (interspace), with lamina of two different vertebrae on the right (caudad) and on the left (cephalad). The elements of the interspace can be easily identified, including distinct images of the posterior dura mater, the epidural space and the ligamentum flavum. The vertebral body-posterior longitudinal ligament-anterior dura mater is seen as a single unit. #PainManagement #Anatomy #POCUS #Spinal #Epidural #Anesthesia #Paramedian #Longitudinal #Parasagittal #Lumbar #Sacrum
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