Ultrasound-guided intrathecal anesthesia: Does scanning help?

Abdelhamid, Sherif A.; Mansour, Magdy A.

doi:10.1016/j.egja.2013.06.003

Cited by 18 publications

(27 citation statements)

References 15 publications

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“…[27][28][29]34 Since a previous review, 43 more data have become available for non-obstetric patients 22,25,26,33,37,[39][40][41] and for patients presumed at risk for difficult insertion due to obesity, scoliosis, or previous surgery. 33 These special patient populations are clinically important because they are at increased risk for technical difficulty.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Does Neuraxial Ultrasound Improve the Efficacy Or Safety Of mentioning

confidence: 99%

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Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

Perlas

Chaparro

Chin

2016

Regional Anesthesia and Pain Medicine

278

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We know that neuraxial ultrasound is a useful complement to clinical examination when performing lumbar central neuraxial blocks. It provides anatomical information including the depth of the epidural space, the identity of a given intervertebral level, and the location of the midline and interspinous/interlaminar spaces. This information can be used to successfully guide subsequent needle insertion.Since 2010, new data from RCTs and 1 meta-analysis suggest that neuraxial ultrasound increases the success and reduces the technical difficulty of lumbar central neuraxial blocks. Findings from the meta-analysis suggest that neuraxial ultrasound reduces the risk of traumatic procedures, and thus may possibly contribute to the safety of lumbar central neuraxial blocks.

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Section: Discussionmentioning

confidence: 99%

Section: Does Neuraxial Ultrasound Improve the Efficacy Or Safety Of mentioning

confidence: 99%

Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

Perlas

Chaparro

Chin

2016

Regional Anesthesia and Pain Medicine

278

View full text Add to dashboard Cite

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“…Previous studies examining the effect of neuraxial ultrasound on patient experience have only scanned women in the ultrasound arm . Exposure to an extra procedure might bias women's perceptions, but we scanned women in both arms to negate this.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound‐assisted neuraxial techniques may facilitate central neuraxial blockade by improving technical performance assessed by the number of needle movements , patient experience and quality of analgesia . Potential risks occur when placement of central neuraxial blockade is more cephalad than intended , which may be compounded by a spinal cord extending more caudad than expected , and an intercristal line that is an unreliable landmark in obesity and pregnancy .…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial comparing needle movements during combined spinal‐epidural anaesthesia with and without ultrasound assistance

et al. 2018

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Ultrasound assistance for neuraxial techniques may improve technical performance; however, it is unclear which populations benefit most. Our study aimed to investigate the efficacy of neuraxial ultrasound in women having caesarean section with combined spinal-epidural anaesthesia, and to identify factors associated with improved technical performance. Two-hundred and eighteen women were randomly allocated to ultrasound-assisted or control groups. All the women had a pre-procedure ultrasound, but only women in the ultrasound group had this information conveyed to the anaesthetist. Primary outcomes were first-pass success (a single needle insertion with no redirections) and procedure difficulty. Secondary outcomes were block quality, patient experience and complications. Exploratory sub-group analysis and regression analysis were used to identify factors associated with success. Data from 215 women were analysed. First-pass success was achieved in 67 (63.8%) and 42 (38.2%) women in the ultrasound and control groups, respectively (adjusted p = 0.001). Combined spinal-epidural anaesthesia was 'difficult' in 19 (18.1%) and 33 (30.0%) women in the ultrasound and control groups, respectively (adjusted p = 0.09). Secondary outcomes did not differ significantly. Anaesthetists misidentified the intervertebral level by two or more spaces in 23 (10.7%) women. Sub-group analysis demonstrated a benefit for ultrasound in women with easily palpable spinous processes (adjusted p = 0.027). Regression analysis identified use of ultrasound and easily palpable spinous processes to be associated with first-pass success.

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“…Many studies that have evaluated the use of neuraxial ultrasound in the obstetric setting have controlled for variability in provider expertise by having clinicians who are experienced in the technique perform the preprocedural ultrasound examination [1,5,14,24–26]. In many cases, the results of the ultrasound exam are relayed in the form of skin markings to a separate care provider who completes the neuraxial procedure.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Spinal Anesthesia Placement Using Automated Interpretation of Lumbar Ultrasound Images: A Prospective Randomized Controlled Trial

Singla¹,

Dixon²,

Sheeran³

et al. 2019

J Anesth Clin Res

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Background: This study evaluated the efficacy of spinal anesthesia administration by resident physicians when using an ultrasound system with automated neuraxial landmark detection capabilities. Methods: 150 patients were enrolled in this trial. Anesthesiology residents placed spinals in subjects undergoing scheduled cesarean delivery using one of three techniques to identify neuraxial landmarks: palpation, ultrasound, or combined palpation and ultrasound. Ultrasound was performed using a handheld system that automatically identified neuraxial landmarks (e.g. midline, intervertebral spaces). All residents watched a 10-minute video and received 20 minutes of hands-on training prior to participating in the study. First insertion success rate was the primary end point. Results: Among all patients, use of ultrasound resulted in a 11% greater first-insertion success rate (RR: 1.11 [0.85–1.47], p=0.431), a 15% reduction in needle insertions (RR: 0.85, p=0.052), and a 26% decrease in needle passes (RR: 0.74, p=0.070). In obese patients of BMI ≥ 30 kg/m 2 , use of ultrasound resulted in 26% greater first-insertion success rates (RR: 1.26, p=0.187), a 21% decrease in needle insertions (RR: 0.79, p=0.025), a 38% decrease in needle passes (RR: 0.62, p=0.030), and a 75% decrease in patients reporting neutral or low patient satisfaction with anesthesia administration (RR: 0.25, p=0.004). Discussion: Resident anesthesiologists competently utilized the ultrasound system after receiving minimal training. Technical endpoints and patient satisfaction trended towards improvement when ultrasound was used prior to spinal placement, with stronger trends observed in obese patients. Additional study is required to fully characterize the impact of the ultrasound system on clinical efficacy.

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Ultrasound-guided intrathecal anesthesia: Does scanning help?

Cited by 18 publications

References 15 publications

Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

A randomised controlled trial comparing needle movements during combined spinal‐epidural anaesthesia with and without ultrasound assistance

Feasibility of Spinal Anesthesia Placement Using Automated Interpretation of Lumbar Ultrasound Images: A Prospective Randomized Controlled Trial

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