Pre-Procedure Neuraxial Ultrasound in Obstetric Anesthesia

Vallejo, Manuel C.

doi:10.24015/japm.2017.0050

Cited by 4 publications

(5 citation statements)

References 24 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vallejo et al . [ 17 ] in a prospective randomized nonblinded study randomized 370 parturient requesting labor epidural analgesia to receive their epidural by first-year anesthesia residents with or without prior ultrasound determination of epidural space depth. They found that the incidence of epidural catheter replacement for failed analgesia was fewer in the ultrasound group and the number of attempts and accidental dural punctures were also lesser in ultrasound group when compared to palpatory group.…”

Section: Discussionmentioning

confidence: 99%

Ease of lumbar epidural catheter insertion with prepuncture ultrasound as guidance compared with conventional palpatory technique when performed by anesthesiology residents

Jagadish

Bidkar

Gupta

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

View full text Add to dashboard Cite

Background and Aims: Lumbar epidural catheter insertion is conventionally performed by anesthesia residents by palpation of anatomical landmarks with relatively blind localization of epidural space which may lead to an increase in failure rate. We aim to compare the ease of lumbar epidural catheterization using prepuncture ultrasound as guidance with that of conventional palpatory technique. Comparisons were made with reference to number of insertion attempts, total time taken for the procedure, frequency of dural puncture, and overall satisfaction score as assessed by Likert's scale. Material and Methods: Eighty, ASA 1-3, patients undergoing elective surgeries requiring lumbar epidural catheterization were recruited for the study. Study participants were randomized into two groups. In group P, epidural catheterization was performed using the conventional palpatory method and in group U, it was performed with the help of ultrasound determined parameters. Number of insertion attempts, total time taken for successful insertion of epidural catheter, frequency of dural puncture, and overall satisfaction of ease of insertion as determined by Likert's scale were compared between both the groups. Data were analyzed using SPSS statistical software version 17 and P value <0.05 was considered statistically significant. Results: The number of insertion attempts was significantly lesser in Group U ( P = 0.019). The total procedure time was significantly higher in group U ( P < .001). There was no significant difference in ease of insertion score, as measured by Likert's scale between both the groups ( P = 0.45). Conclusion: Prepuncture ultrasound guidance improves the first attempt success rate of lumbar epidural catheterization with reduced incidence of dural puncture with similar overall satisfaction score but increases the total time taken for the procedure when compared to conventional palpatory technique.

show abstract

Section: Discussionmentioning

confidence: 99%

Ease of lumbar epidural catheter insertion with prepuncture ultrasound as guidance compared with conventional palpatory technique when performed by anesthesiology residents

Jagadish

Bidkar

Gupta

et al. 2021

Journal of Anaesthesiology Clinical Pharmacology

View full text Add to dashboard Cite

show abstract

“…Furthermore, obese patients are more likely to experience a longer procedure time, a higher incidence of accidental dural puncture, a higher incidence of epidural venous puncture, and higher overall failure and complication rates during neuraxial anesthesia placement. [ 76 77 ] Neuraxial US (pre-procedural or real-time) can be used to identify the intervertebral space(s), the midline for insertion, determine the depth from the skin to the epidural space, the best needle insertion point, and the best angle for needle insertion. [ 77 ] This leads to decrease of the number of attempts required for epidural placement, the risk for epidural hematoma, and post-surgical low back pain.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…[ 76 77 ] Neuraxial US (pre-procedural or real-time) can be used to identify the intervertebral space(s), the midline for insertion, determine the depth from the skin to the epidural space, the best needle insertion point, and the best angle for needle insertion. [ 77 ] This leads to decrease of the number of attempts required for epidural placement, the risk for epidural hematoma, and post-surgical low back pain. [ 77 ] The use of pre-procedural US imaging has shown a higher first-attempt success rate for epidural catheter placement, less need for needle repositioning, which leads to shorter total procedure time.…”

Section: Regional Analgesiamentioning

confidence: 99%

“…[ 77 ] This leads to decrease of the number of attempts required for epidural placement, the risk for epidural hematoma, and post-surgical low back pain. [ 77 ] The use of pre-procedural US imaging has shown a higher first-attempt success rate for epidural catheter placement, less need for needle repositioning, which leads to shorter total procedure time. A randomized controlled study done by Vernon et al [ 78 ] regarding US-assisted epidural labor analgesia in obese women stated that although US assessment took more time than palpation method, this assessment leads to less time to identify the space, fewer trials, know the depth of the epidural or subarachnoid space and avoid false sensation of loss of resistance.…”

Section: Regional Analgesiamentioning

confidence: 99%

See 1 more Smart Citation

The role of ultrasonography in anesthesia for bariatric surgery

et al. 2022

View full text Add to dashboard Cite

Bariatric surgeries are effective long-term management for morbid obesity with its adverse sequelae. Anesthesia of bariatric surgeries poses unique challenges for the anesthesiologist in every step starting with vascular access till tracheal extubation. The usage of ultrasound in anesthesia is becoming more prevalent with a variety of benefits, especially in the obese population. Ultrasound is successfully used for obtaining vascular access, with more than 15 million catheters placed in the United States alone. Ultrasound can also be used to predict difficult intubation, as it can confirm the tracheal intubation and assess the gastric content to prevent pulmonary aspiration. Ultrasound is also used in the management of mechanically ventilated patients to monitor lung aeration and to identify respiratory complications during positive pressure ventilation. Moreover, intraoperative echocardiography helps to discover the pulmonary embolism and guides the fluid therapy. Finally, ultrasound can be used to perform neuraxial and fascial plane block with a less overall time of the procedures and minimal complications. The wide use of ultrasound in bariatric anesthesia reflects the learning curve of the anesthesiologists and their mounting efforts to provide safe anesthesia utilizing the updated technology. In this review, we highlight the role of ultrasonography in anesthesia of bariatric surgery and discuss the recent guidelines.

show abstract

“…Ultrasound guided placement (US) could be a method of improving speed of placement of neuraxial analgesia as it provides an opportunity to directly visualize landmarks which have traditionally been located by palpation. US guidance for regional anesthesia has gained tremendous popularity over the past 15 years [5][6][7][8]. In a literature review published in 2016 by Soni et al, 20 randomized trials and 2 meta-analysis comparing landmark-based versus ultrasound-guided techniques for lumbar puncture or epidural/spinal anesthesia, showed a large advantage of the US technique in different patient populations, using different outcomes (see Table 1) [9].…”

Section: Introductionmentioning

confidence: 99%

Does Pre-Procedure Neuraxial Ultrasound Using the GE Logiq® Improve Midline Placement of Combined Spinal Epidural when Compared to a Palpation Technique Performed by Experienced Anesthesiologists? A Prospective Randomized Study

Orlando¹,

Donovan²,

Stein³

et al. 2021

Journal of Scientific Innovation in Medicine

View full text Add to dashboard Cite

Background: Neuraxial placement relies on palpation of anatomical landmarks, sometimes challenging to identify. Ultrasound (US) has helped facilitate those procedure. We wanted to assess efficacy of the US compared to landmark techniques when used by experienced obstetric anesthesiologists. Methods:We conducted a randomized prospective trial of healthy parturients requesting neuraxial labor analgesia. Positive CSF through the 27 G Pencan spinal needle at the first interspace attempted was the primary outcome. Secondary outcomes were the number of attempts and the number of needle adjustments within a space, presence of symmetrical analgesia 2 hours after placement, and need for epidural replacement. The procedures were performed by practitioners experienced in obstetric anesthesia, including obstetric anesthesiology fellows, and attending physicians who received a video training of the US technique prior to the study [1].Results: Forty-eight patients were randomized to either the US or landmark group. Two patients (one in each group) were excluded from the study due to delivery within 2 hours of CSE (Combined Spinal Epidural) placement. One patient in the landmark group was excluded due to a wet tap. No statistical difference was found regarding positive CSF flow on first attempt at CSE (p = 0.6). All secondary outcomes were statistically insignificant as well: number of spaces attempted (p = 0.71 95% CI -0.30 to 0.21), number of needle adjustments (p = 0.09, 95% CI -0.10 to 1.28), presence of symmetrical anesthesia at 2 hours (p = 1) and need for epidural replacement (p = 0.48). Conclusions:When placed by an experienced obstetric anesthesiology fellow or attending physician, there is no difference in the successful placement of CSE with US versus landmark technique.

show abstract

Pre-Procedure Neuraxial Ultrasound in Obstetric Anesthesia

Cited by 4 publications

References 24 publications

Ease of lumbar epidural catheter insertion with prepuncture ultrasound as guidance compared with conventional palpatory technique when performed by anesthesiology residents

Ease of lumbar epidural catheter insertion with prepuncture ultrasound as guidance compared with conventional palpatory technique when performed by anesthesiology residents

The role of ultrasonography in anesthesia for bariatric surgery

Does Pre-Procedure Neuraxial Ultrasound Using the GE Logiq® Improve Midline Placement of Combined Spinal Epidural when Compared to a Palpation Technique Performed by Experienced Anesthesiologists? A Prospective Randomized Study

Contact Info

Product

Resources

About