Ultrasonography is routinely performed during pregnancy by obstetricians to visualize the
fetus, making patients familiar and comfortable with its usage. Ultrasonography does not
result in adverse effects to the mother or fetus and is readily available at most
facilities, yet is not routinely used to identify lumbar interspaces prior to providing
neuraxial anesthesia. Ultrasonography is a valuable tool for accurately identifying lumbar
intervertebral spaces and is more accurate than simple palpation of obscure anatomic
landmarks. The investigators are interested to know the accuracy of anatomic landmark
palpation in predicting the lumbar interspace of neuraxial anesthesia administration
compared to identification of the interspace by ultrasound. The investigators are also
interested in presenting anesthesia providers with feedback regarding their accuracy and
then investigating whether this feedback causes a change in provider practice (i.e. use of
ultrasound) or improved identification of the interspace prior to providing neuraxial
Informed consent will be obtained and documented. All post-partum patients who received
neuraxial anesthesia will be asked to provide consent for ultrasound to be used at their
bedside to identify the interspace where the neuraxial anesthetic was administered. A low
frequency ultrasound probe and sterile gel will be used to perform the less than five-minute
study. The site of the neuraxial anesthetic placement will be identified by the puncture
mark on the skin. The investigators will note the patient's medical record number and BMI,
the names of the resident and attending anesthesiologist who placed the neuraxial
anesthetic, the documented intervertebral space at the time of neuraxial anesthetic
placement, anesthetic type, whether ultrasound was used for the initial neuraxial placement,
and the documented intervertebral space identified post-partum by ultrasound.
Following 3 months of data collection, information regarding the documented intervertebral
space versus the actual intervertebral space that the neuraxial anesthetic was administered
will be provided to each anesthesiologist and resident. Following delivery of this
information, an additional 3 months of data collection will be performed (the same as the
first 3 months) to evaluate whether a practice change took place.
Inclusion Criteria: All post-partum patients > 18 years old who had neuraxial anesthesia
for delivery and are English Speaking.
Exclusion Criteria: Age < 18 years and non-English speaking, and did not have neuraxial
anesthesia for delivery.