Level of difficulty of applying epidural anaesthesia
(Score according to Prof. A.M. Ali, University of Cairo)
In June 2005, Prof. A.M. Ali of Cairo University visited our clinic to present a scoring system he developed to assess the level of difficulty of applying epidural anaethesia. The scoring system awards a total of 4 points - i.e. max. 2 points for the characteristic of the bone structures, and max. 2 points for the characteristic of the tissue around the spinal column.
(PDF file - German 
; PDF file - English 
)
I. Characteristic of bone structures:
1. Inspection and palpation of the spinous processes:
a, good to see and feel: 0 points
b, can neither be seen nor felt: 1 point
2. Course of spinal column:
a, normal and straight: 0 points
b, scoliosis or hyperlordosis / hyperkyphosis: 1 point
II. Characteristic of soft tissue structures:
3. Presence of scars, fibroses or calcifications:
a, normal soft tissue without scars or calcifications: 0 points
b, presence of scars or calcifications: 1 point
4. Presence of edemas and/or very tough skin:
a, smooth skin without edemas: 0 points
b, very tough skin with or without edemas: 1 point
Interpretation:
0 - 1 points: application of epidural anaesthesia can be expected to be simple and without complications
2 - 3 points: application of epidural anaesthesia may prove to be difficult; an experienced anaethetist should be trusted with doing the puncture
4 points: application of epidural anaesthesia will definitely be difficult; some extra examinations such as x-ray or NMR images of the spinal column plus ultrasound examinations recommeded.