Can pre-procedure neuroaxial ultrasound improve the identification of the potential epidural space when compared with anatomical landmarks? A prospective randomized study

Perna, Paolo; Gioia, Antonio; Ragazzi, Riccardo; Volta, Carlo Alberto; Innamorato, Massimo

doi:10.23736/s0375-9393.16.11399-9

Cited by 14 publications

(10 citation statements)

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“…In eight trials, the indication for the neuraxial procedure was labour analgesia [17,18,23,28,29,32,35,37], in 13 trials, it was for elective caesarean section [16, 19-22, 24, 26, 27, 30, 31, 33, 34, 36], and in one trial, it was labour analgesia or elective caesarean section [25]. The neuraxial technique was combined spinalepidural [19,24,26,28,36], epidural [17,18,23,25,29,31,32,35,37] or spinal [16, 20-22, 27, 30, 33, 34] in five, nine and eight trials, respectively. In two trials, the neuraxial technique was predicted to be easy [16,17], whereas it was predicted to be difficult in seven trials [20,22,23,27,32,34,36] and heterogeneous in 10 trials [18, 19, 21, 28-31, 33, 35, 37].…”

Section: Resultsmentioning

confidence: 99%

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Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a systematic review and meta‐analysis with trial sequential analyses

2020

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The aim of this systematic review and meta-analysis was to examine the efficacy, time taken and the safety of neuraxial blockade performed for obstetric patients with the assistance of preprocedural ultrasound, in comparison with the landmark palpation method. The bibliographic databases Central, CINAHL, EMBASE, Global Health, MEDLINE, Scopus and Web of Science were searched from inception to 13 February 2020 for randomised controlled trials that included pregnant women having neuraxial procedures with preprocedural ultrasound as the intervention and conventional landmark palpation as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenszel method. In all, 22 trials with 2462 patients were included. Confirmed by trial sequential analysis, preprocedural ultrasound increased the first-pass success rate by a risk ratio (95%CI) of 1.46 (1.16-1.82), p = 0.001 in 13 trials with 1253 patients. No evidence of a difference was found in the total time taken between preprocedural ultrasound and landmark palpation, with a mean difference (95%CI) of 50.1 (À13.7 to 113.94) s, p = 0.12 in eight trials with 709 patients. The quality of evidence was graded as low and very low, respectively, for these co-primary outcomes. Sub-group analysis underlined the increased benefit of preprocedural ultrasound for those in whom the neuraxial procedure was predicted to be difficult. Complications, including postpartum back pain and headache, were decreased with preprocedural ultrasound. The adoption of preprocedural ultrasound for neuraxial procedures in obstetrics is recommended and, in the opinion of the authors, should be considered as a standard of care, in view of its potential to increase efficacy and reduce complications without significant prolongation of the total time required.

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Section: Resultsmentioning

confidence: 99%

“…Of the original 4978 unique records identified by our search strategy, 22 randomised controlled trials met the inclusion criteria [16–37]. Details of the screening process are shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a systematic review and meta‐analysis with trial sequential analyses

2020

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“…These individual studies demonstrated similar benefits of using ultrasound guidance: reduced needle insertion attempts, reduced needle redirections, and increased overall procedural success rates. 17,31,37,40,41,[43][44][45][46][47][48][49] It is important to recognize that four randomized controlled studies did not demonstrate any benefits of ultrasound guidance on the number of attempts or procedural success rates, 23,33,41,51 and three of these studies were included in the abovementioned meta-analyses. 23,33,51 Limitations of these negative studies include potential selection bias, inadequate sample sizes, and varying levels of operator skills in procedures, ultrasound guidance, or both.…”

Section: Clinical Outcomes 1) When Ultrasound Equipment Is Available Along With Providers Who Are Appropriately Trained To Use It We Recomentioning

confidence: 99%

“…Most of the randomized controlled studies demonstrating benefits of using ultrasound guidance compared with landmark guidance for performance of LP, epidural anesthesia, or spinal anesthesia have used a low-frequency, curvilinear transducer. 22,24,[26][27][28]31,[34][35][36]39,[43][44][45]67 Two randomized controlled trials used a high-frequency linear transducer for site marking of lumbar procedures. 30,32,37 Using a high-frequency linear transducer has been described in real-time, ultrasound-guided LPs, the advantage being better needle visualization with a linear transducer.…”

Section: ) We Recommend That a Low-frequency Transducer Preferably A Curvilinear Array Transducer Should Be Used To Evaluate The Lumbar Smentioning

confidence: 99%

“…Although no studies have directly compared different ultrasound scanning protocols to map the lumbar spine, starting at the level of the sacrum and sliding the transducer cephalad to sequentially identify the lumbar interspinous spaces is the most commonly described technique in studies demonstrating improved clinical outcomes with the use of ultrasound. 24,31,34,37,39,40,45,56,57,67 Because the sacrum can be easily recognized, identifying it first is most beneficial in patients with few or no palpable landmarks.…”

Section: ) We Recommend That Ultrasound Should Be Used To Map the Lumbar Spine Starting At The Level Of The Sacrum And Sliding The Transdmentioning

confidence: 99%

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Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine

Soni

Franco‐Sadud

Kobaidze

et al. 2019

Journal of Hospital Medicine

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EXECUTIVE SUMMARY 1) When ultrasound equipment is available, along with providers who are appropriately trained to use it, we recommend that ultrasound guidance should be used for site selection of lumbar puncture to reduce the number of needle insertion attempts and needle redirections and increase the overall procedure success rates, especially in patients who are obese or have difficult‐to‐palpate landmarks. 2) We recommend that ultrasound should be used to more accurately identify the lumbar spine level than physical examination in both obese and nonobese patients. 3) We suggest using ultrasound for selecting and marking a needle insertion site just before performing lumbar puncture in either a lateral decubitus or sitting position. The patient should remain in the same position after marking the needle insertion site. 4) We recommend that a low‐frequency transducer, preferably a curvilinear array transducer, should be used to evaluate the lumbar spine and mark a needle insertion site. A high‐frequency linear array transducer may be used in nonobese patients. 5) We recommend that ultrasound should be used to map the lumbar spine, starting at the level of the sacrum and sliding the transducer cephalad, sequentially identifying the lumbar spine interspaces. 6) We recommend that ultrasound should be used in a transverse plane to mark the midline of the lumbar spine and in a longitudinal plane to mark the interspinous spaces. The intersection of these two lines marks the needle insertion site. 7) We recommend that ultrasound should be used during a preprocedural evaluation to measure the distance from the skin surface to the ligamentum flavum from a longitudinal paramedian view to estimate the needle insertion depth and ensure that a spinal needle of adequate length is used. 8) We recommend that novices should undergo simulation‐based training, where available, before attempting ultrasound‐guided lumbar puncture on actual patients. 9) We recommend that training in ultrasound‐guided lumbar puncture should be adapted based on prior ultrasound experience, as learning curves will vary. 10) We recommend that novice providers should be supervised when performing ultrasound‐guided lumbar puncture before performing the procedure independently on patients.

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Neuraxial Labor Analgesia Technique: Comparison of Intervertebral Lumbar Level Space Detection by Digital Palpation and Ultrasonography

Kuczkowski¹

2021

Intrapartum Ultrasonography for Labor Management

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Can pre-procedure neuroaxial ultrasound improve the identification of the potential epidural space when compared with anatomical landmarks? A prospective randomized study

Cited by 14 publications

References 0 publications

Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a systematic review and meta‐analysis with trial sequential analyses

Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a systematic review and meta‐analysis with trial sequential analyses

Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine

Neuraxial Labor Analgesia Technique: Comparison of Intervertebral Lumbar Level Space Detection by Digital Palpation and Ultrasonography

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