Study intervention
INFILTRATION, DECUBITUS
Labor CSE analgesia was performed with the patient in the lateral decubitus position. In the ultrasound group, a wireless handheld ultrasound device (Accuro, Rivanna Medical, Charlottesville, VA, USA) equipped with pattern recognition software was used to identify bony landmarks and estimate the depth of the epidural space. Before skin disinfection, a preprocedural examination was done using the handheld ultrasound at the L4/5 and L3/4 levels, as described previouslyIn both groups, lidocaine skin infiltration was performed at the planned puncture site. A schematic of the CSE procedure is shown in Fig. The diagram of the combined spinal-epidural analgesia procedure. The anesthesiologist formally graded the ease of landmark palpation on a 4-point scale (easy, moderate, difficult, or impossible) after the completion of the procedure to ensure that the procedural time included only the time essential to the CSE procedure in both groups