Identification of L3-L4 Interspace in Parturients

This will be an observational education based study to improve anesthesiology resident's ability to correctly identify the L3-L4 interspace. Residents who agree to participate in the study will be trained using ultrasound to identify the L3-L4 interspace during their rotation on the obstetric anesthesia service. Training will include using the ultrasound to correlate the surface palpation with the underlying structures. This will be supplemented with teaching videos and literature. The training will be performed for the first three weeks of the four week rotation.

After undergoing this training program, during the fourth week of the rotation, the residents will be asked to perform palpation identification of the L3-L4 interspace on parturients. Ultrasound will be used to assess the accuracy of the identified level. These assessments will repeated at six and 12 months to assess whether the skill has been retained.

Inclusion criteria

• term gestation (at least 38 weeks gestation)

Exclusion criteria

• Prior back surgery
• Previously diagnosed skeletal deformities such as scoliosis
• BMI greater than 40
• Height less than 60 inches
• Patient discomfort requiring immediate analgesia