Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials

Jiang, Lianxiang; Zhang, Fang; Wei, Na; Lv, Jingjing; Chen, Wei; Zhang, Dai

doi:10.1007/s00540-020-02750-6

Cited by 12 publications

(8 citation statements)

References 28 publications

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“…In general, neuraxial blockade is more difficult in an older population than in relatively younger obstetric patients, possibly due to degenerative changes of the lumbar spine, such as the calcified interspinous ligament and limited lumbar flexion [ 39 ]. These findings supported that preprocedural US imaging may be more beneficial in patients with difficult anatomy, as shown in a recent meta-analysis [ 41 ]. Scanning both sides and all spinal levels before selecting a puncture site for US-guided spinal anesthesia is recommended.…”

Section: Up-to-date Literature Reviewsupporting

confidence: 86%

Ultrasonography for lumbar neuraxial block

et al. 2020

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Ultrasonography can be useful to perform a lumbar neuraxial block. It aids in understanding the anatomy of the lumbar spine before the procedure. Pre-procedural ultrasound imaging provides information about the accurate intervertebral level for puncture, optimal needle insertion point, and depth of needle advancement for a successful neuraxial block. The key ultrasonographic views for lumbar neuraxial block include the transverse midline interlaminar and parasagittal oblique views. Ultrasonography can facilitate lumbar neuraxial block in difficult cases, such as the elderly, obese patients, and patients with anatomical abnormality of the lumbar spine. This review elucidates the basics of spinal ultrasonography for lumbar neuraxial block and the current evidence regarding ultrasound-guided neuraxial block in adults.

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Section: Up-to-date Literature Reviewsupporting

confidence: 86%

Ultrasonography for lumbar neuraxial block

et al. 2020

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“…In a subgroup of patients receiving epidural or CSE, the first pass success rate was equivocal for epidural (RR 1.20, 95% CI 0.88–1.64) but improved with use of ultrasound for CSE placement (RR 1.63, 95% CI 1.18–2.25). Incidence of vascular puncture was reduced with ultrasound in the combined epidural/CSE subgroup (RR 0.39, 95% CI 0.18–0.89), though quality of anesthesia was not mentioned 10 . A further meta‐analysis looking at epidural, but not limited to obstetric patients (nine studies, 1014 patients), looked at efficacy, including requirement for replacement for operative delivery of labor analgesia and ability to place the catheter.…”

Section: Methodsmentioning

confidence: 99%

“…Incidence of vascular puncture was reduced with ultrasound in the combined epidural/CSE subgroup (RR 0.39, 95% CI 0.18-0.89), though quality of anesthesia was not mentioned. 10 A further meta-analysis looking at epidural, but not limited to obstetric patients (nine studies, 1014 patients), looked at efficacy, including requirement for replacement for operative delivery of labor analgesia and ability to place the catheter. Pre-procedural ultrasound reduced the risk of both failed epidural (mean difference [MD] 0.23, 95% CI 0.09-0.60) and of traumatic insertion of epidural (MD 0.28, 95% CI 0.09-0.92).…”

Section: Ultrasoundmentioning

confidence: 99%

Epidural analgesia in labor: A narrative review

Halliday

Nelson

Kearns

2022

Intl J Gynecology & Obste

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Lumbar epidural is considered the gold standard for analgesia in labor and is recommended by WHO, with estimates of use in the range of 10%-64% in high-income countries. 1 During labor, uterine contraction and cervical dilatation stimulate nociceptive afferent fibers that travel to spinal nerves T10-L1, producing poorly localized visceral pain. As the fetal head descends, stretching the perineum and vagina, pain fibers via the pudendal nerve and spinal roots S2-4 are also activated. 2 To modify these afferent pathways and achieve analgesia, local anesthetics, opioids, and other adjuvants can be administered to the epidural space by an epidural catheter. Despite widespread use, there are many uncertainties regarding the optimal epidural regime. Different combinations and concentrations of drugs administered epidurally have been shown to have varying effects in both the partum and postpartum periods. With so many variables surrounding childbirth, it can be difficult to separate association and causation. Epidurals are associated with, but probably do not cause, prolonged labor and increased risk of operative delivery. 3 These factors directly affect obstetric decision making. For certain maternal conditions that may be decompensated by labor and delivery, such as pre-eclampsia or cardiac disease, labor epidural is indicated. In cases where epidural is contraindicated (such as severe thrombocytopenia, coagulopathy, or sepsis) other analgesic regimes (e.g. patient-controlled remifentanil) may be available.Improving communication and understanding between anesthetists and obstetricians is mutually beneficial. The aim of the present narrative review was to provide an overview of epidural literature for the obstetric audience, incorporating techniques of insertion, medications used, and associations with maternal and neonatal outcomes.Spinal anesthesia, and the use of epidural anesthesia for cesarean/ operative delivery are outwith the scope of the present review. | ME THODS | Search strategyA literature search without language restriction was conducted (MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, and Cochrane Central Register of Controlled Trials [CENTRAL]) from date of inception to October 5, 2020. Randomized controlled trials (RCTs), reviews, and relevant references were included. Search terms were "neuraxial analgesia," "epidural," "peridural," "combined spinal-epidural," "CSE,"

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“…With regards to the literature, one study conducted by Jiang et al showed increased first- pass success rates in patients with greater predicted puncture difficulty but not in patients who were easily punctured ( 39 ). Both techniques involve identifying the desired intervertebral space, numbing the area in which the needle will be inserted with local anesthesia, and advancing the needle through the skin, soft tissue, and spinal ligaments until the epidural space (epidural block) or subarachnoid space (spinal block) is reached.…”

Section: Resultsmentioning

confidence: 99%

Current Strategies in Pain Regimens for Robotic Urologic Surgery: A Comprehensive Review

et al. 2022

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Context: Robotic surgery is becoming the most common approach in minimally invasive urologic procedures. Robotic surgery offers less pain to patients because of smaller keyhole incisions and less tissue retraction and stretching of fascia and muscular fibers. Tailored pain regimens have also evolved and allowed patients to feel minimal to no discomfort after robotic urologic surgery, allowing in parallel better surgical outcomes. This study aims to analyze the most current pain regimens in robotic urologic surgery and to evaluate the most current pain protocols and corresponding outcomes. Evidence Acquisition: A literature review was performed of published manuscripts utilizing Pubmed and Google Scholar on pain protocols for patients undergoing robotic urologic surgery. Results: Multimodal analgesia is gaining ground in robotic urologic surgery. Regional analgesia includes four major modalities: Neuroaxial analgesia, intercostal blocks, tranvsersus abdominis plane blocks, and paravertebral blocks. Each approach has a different injection site, region of analgesia coverage, and duration of coverage depending upon local anesthesia and/or adjuvant utilized with advantages and disadvantages that make each modality unique and efficacious. Conclusions: Robotic urologic surgery has offered the advantage of smaller incisions, faster recovery, less postoperative opioid consumption, and better surgical outcomes. Neuraxial, intercostal, transversus abdominis plane, and quadratus lumborum blocks are the best and most adopted approaches which offer optimal outcomes to patients.

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Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials

Cited by 12 publications

References 28 publications

Ultrasonography for lumbar neuraxial block

Ultrasonography for lumbar neuraxial block

Epidural analgesia in labor: A narrative review

Current Strategies in Pain Regimens for Robotic Urologic Surgery: A Comprehensive Review

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