Real-time ultrasound-guided vs. anatomical landmark-guided paramedian epidural anesthesia in overweight parturients undergoing analgesic labor: a randomized controlled trial

Abstract

We evaluated whether real-time ultrasound-guided epidural block is more suitable for overweight parturients undergoing analgesic labor than traditional palpation positioning. Sixty overweight at-term pregnant women (body mass index ≥30 kg/m2) with singleton pregnancy, prepared for vaginal delivery with epidural analgesia, were randomly allocated into two groups. The parturients in the anatomical landmark catheterization group received paramedian epidural anesthesia using the anatomical landmark-guided technique, while real-time ultrasound-guided positioning was performed in the ultrasound-guided-catheterization group. Total procedure duration, time to identify the puncture site and perform the puncture, first attempt success rate, number of attempts, number of needle-redirections, intervertebral-space-change rate, satisfaction score, and complications were compared between the groups. Procedure duration and time to identify the puncture site were significantly shorter in the anatomical landmark catheterization group (440.1 ± 97.2 s vs. 521.9 ± 68.4 s, p < 0.001 and 24.9 ± 13.6 s vs. 112.2 ± 15.6 s, p < 0.001, respectively). There was no significant difference in the time to perform the puncture (385.3 ± 89.7 s vs. 365.1 ± 73.0 s, p = 0.341). The first attempt success rate was lower while the number of attempts and number of needle-redirections were higher in the anatomical landmark catheterization group (p < 0.05). The intervertebral-space-change rate was similar across the groups. Satisfaction was significantly lower in the ultrasound-guided catheterization group (p = 0.009). Complication occurrence, e.g., catheterization difficulty or bleeding during catheterization, dural puncture, and lower-back pain, was similar across the groups. Real-time ultrasound-guided paramedian epidural anesthesia improved the first attempt success rate and reduced the number of attempts and number of needle-redirections in overweight parturients undergoing analgesic labor. However, the longer total procedure duration and time to identify the puncture site might dissatisfy parturients.

Comparison of ultrasound-guided and traditional localisation in intraspinal anesthesia: a systematic review and network meta-analysis

“…Nineteen two-arm studies and one three-arm study documented first-pass success rates and were pooled for analysis 2 3 11–17 19–27 29 30. Across all studies, traditional positioning was the most frequently cited (online supplemental figure 1A).…”

“…A total of 16 trials provided data on first-attempt success rates 2 3 11 12 14 18–22 24–28 30. The network node diagram is shown in online supplemental figure 2A.…”

“…The network diagrams and forest diagrams of each study are shown in online supplemental figure 3A,B. The results2 3 11 12 17–19 21–23 26 27 30 show that the traditional positioning method has the shortest positioning time (online supplemental figure 3D), but the ultrasound-assisted and real-time guided puncture positioning time does not show significant differences (online supplemental figure 3C). The funnel plot is shown in figure 3SE.…”

“…In the first subgroup, we included nine studies in adults with obesity and pregnant women (obese or not), and analysed the results of first pass success rate3 12 13 15 16 20 23 27 29 and first attempt success rate 3 12 18 20 27. For first-pass success rate, a network plot (online supplemental figure 5A), a forest plot for a single study (online supplemental figure 5B), a forest plot for pairwise comparisons (online supplemental figure 5C), a cumulative ranking curve (online supplemental figure 5D) and a funnel plot (online supplemental figure 5E) are shown.…”

“…All experiments were two or three arms. Among them, 13 studies compared ultrasound-assisted localisation with conventional localisation, [11][12][13][14][15][16][17][18][19][20][21][22][23] 5 studies compared ultrasound-assisted localisation with conventional localisation [24][25][26][27][28] and 3 studies compared ultrasoundassisted localisation with real-time guidance in the spinal anaesthesia. 2 3 19 One study compared the use of three methods in spinal anaesthesia.…”