A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients

Abstract

We found a high level of success in the prepuncture ultrasound-determined insertion point. The ultrasound imaging technique can be a reliable guide to facilitate spinal anesthesia, especially in obese parturients.

Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

“…Eight RCTs [27][28][29]32,34,36,38,42 and 2 cohort studies 20,21 evaluated epidural analgesia in obstetric patients, whereas 3 RCTs 33,37,39 and 2 cohort studies 22,26 evaluated spinal anesthesia in orthopedic procedures. The remaining 3 RCTs 35,40,41 and 1 cohort study 25 each evaluated diagnostic lumbar punctures by emergency physicians.…”

“…Fourteen RCTs involving 1768 patients [27][28][29][32][33][34][35][36][37][38][39][40][41][42] (Table 4) and 5 prospective cohort studies involving 227 patients [20][21][22]25,26 examined efficacy and safety outcomes. Eight RCTs [27][28][29]32,34,36,38,42 and 2 cohort studies 20,21 evaluated epidural analgesia in obstetric patients, whereas 3 RCTs 33,37,39 and 2 cohort studies 22,26 evaluated spinal anesthesia in orthopedic procedures.…”

Through a glass darkly - ultrasound imaging in obstetric anaesthesia

“…This effect can be reduced by compression of the adipose tissue, but doing this might lead to underestimation of the depth of the epidural space. Nevertheless, in a study comparing the use of spinal anaesthesia in obese and non-obese parturients, pre-procedure ultrasound was demonstrated to be helpful in reducing the number of puncture attempts; first-attempt success rate in obese parturients was 92% using ultrasound guidance compared with 44% when ultrasound was not used (p < 0.001) [16]. In this study, the obese group had a body mass index of ≥ 30 kg.m…”

Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety

“…Studies report a decrease in number of attempts [41,42], in procedure time [42], and in the number of labor epidural replacements [41]. Correlation between estimated depth to epidural space using ultrasound and actual depth in both non-obese and obese parturients has been reported [43][44][45][46].…”