Lumbar Neuraxial Ultrasound for Spinal and Epidural Anesthesia

Perlas, Anahi; Chaparro, Luis Enrique; Chin, Ki Jinn

doi:10.1097/aap.0000000000000184

Cited by 265 publications

(98 citation statements)

References 47 publications

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“…Specific methodologies for the various components of this project are detailed in the accompanying individual articles. [2][3][4][5][6][7][8][9] In brief, putative evidence was gathered using a variety of standard electronic search engines to identify relevant literature, concentrating on the period from 2009 through spring 2015. The specific search engines used, language limitations, and MeSH (medical subject headings) are described in the individual articles.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, several meta-analyses that include safety issues have been published. 6,12,16 Safety issues related to neuraxial anesthesia were addressed previously in that section.…”

Section: Patient Safetymentioning

confidence: 99%

“…[2][3][4][5][6][7][8][9] Clinicians are encouraged to read these supporting articles for a more complete understanding of the evidence basis for UGRA.…”

mentioning

confidence: 99%

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The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia

Neal

Brull

Horn

et al. 2016

Regional Anesthesia and Pain Medicine

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135

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Scientific evidence from the past 5 years has clarified and strengthened our understanding of ultrasound-guided regional anesthesia as a nerve localization tool. High-level evidence supports ultrasound guidance contributing to superior characteristics with selected blocks, although absolute differences with the comparator technique are often relatively small (especially for upper-extremity blocks). The clinical meaningfulness of these differences is likely of variable importance to individual practitioners. The use of ultrasound significantly reduces the risk of local anesthetic systemic toxicity as well as the incidence and intensity of hemidiaphragmatic paresis, but has no significant effect on the incidence of postoperative neurologic symptoms. WHAT'S NEW IN THIS UPDATE?: This evidence-based assessment of ultrasound-guided regional anesthesia reviews findings from our 2010 publication and focuses on new meta-analyses, randomized controlled trials, and large case series published since 2009. New to this exercise is an in-depth analysis of the accuracy and reliability of ultrasound guidance for identifying needle-to-nerve relationships. This version no longer addresses ultrasound for interventional pain medicine procedures, because the growth of that field demands separate consideration. Since our 2010 publication, new information has either supported or strengthened our original conclusions. There is no evidence that ultrasound is inferior to alternative nerve localization methods.

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Section: Methodsmentioning

confidence: 99%

“…In addition, several meta-analyses that include safety issues have been published. 6,12,16 Safety issues related to neuraxial anesthesia were addressed previously in that section.…”

Section: Patient Safetymentioning

confidence: 99%

See 1 more Smart Citation

The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia

Neal

Brull

Horn

et al. 2016

Regional Anesthesia and Pain Medicine

Self Cite

135

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“…A recent meta-analysis concluded that neuraxial ultrasound more accurately identifies the lumbar intervertebral space over palpation, accurately predicts the distance from the skin to the epidural space, and improves efficacy. 57 However, with some practitioners, the actual depth from the skin to the intended space may differ by as much as 15 mm from that estimated by ultrasound. 7-9,21 Significant training and experience is necessary before one can properly utilize ultrasound for assistance with epidural needle and catheter placement.…”

Section: Discussionmentioning

confidence: 99%

Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord

et al. 2016

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Background Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. Methods For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. Real-time spectral guidance was tested using a 2-mm inner-diameter fiber-optic probe-in-needle device. Raman spectra were collected during the needle’s passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. Results RS revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; diffuse reflectance spectroscopy and fluorescence spectroscopy were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. Conclusions This study demonstrates that RS can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization.

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“…Multiple recently published systematic reviews found ultrasound guidance to improve the performance of the blocks and different patient outcomes [11][12][13][14]. Importantly, the expectation that direct visualization of the neural structures would reduce the incidence of neurologic complications has not been confirmed, but ultrasound guidance has been found to reduce the risk of local anesthetic systemic toxicity and possibly pneumothorax [15 & ].…”

Section: Alternatives To Neuraxial Analgesiamentioning

confidence: 99%