The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks

Ekinci, Mine; Alici, Hacı Ahmet; Ahıskalıoğlu, Ali; İnce, İlker; Aksoy, Mehmet; Çelik, Erkan; Dostbil, Ayşenur; Çelik, Mine; Baysal, Pınar Karaca; Gölboyu, Birzat Emre; Yeksan, Ayşe Nur

doi:10.1016/j.jclinane.2016.10.014

Cited by 28 publications

(21 citation statements)

References 13 publications

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“…The ultrasound-assisted CSE anesthesia technique provides improved precision and efficacy, overcoming the technical difficulties of performing neuraxial blocks [13][14][15][16][17] for obese [18,19], obstetric [20][21][22][23], and aged patients [12,24,25], as well as patients with difficult-todetect and abnormal anatomical surface landmarks [9,26]. However, few studies have focused on ultrasoundassisted CSE anesthesia in elderly patients who have difficulty achieving optimal body positioning.…”

Section: Introductionmentioning

confidence: 99%

Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

Zhang

Jiang

et al. 2020

BMC Anesthesiol

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Background Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods This prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation. Results Eighty patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20 and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5 and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1 [1]) than landmark-guided group (2 [1, 2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1 [1, 2]) than in landmark-guided group (3 [2, 4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4–5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis. Conclusions Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice. Trial registration Chinese Clinical Trial Register (identifier, ChiCTR1900020819; date of registration, January 20, 2019).

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Section: Introductionmentioning

confidence: 99%

Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

Zhang

Jiang

et al. 2020

BMC Anesthesiol

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“…Ultrasound has been widely investigated as a means for identifying neuraxial landmarks prior to performing lumbar neuraxial blockade procedures [6,7,13]. The benefits of preprocedural ultrasound imaging are particularly pronounced in the obese patient population, and several studies have demonstrated that both trainees [5,15,30] and experienced providers [1,14,24,31–33] achieve increased first-insertion success rates and make fewer skin punctures and needle passes when using ultrasound in patients with impalpable landmarks or high BMI. However, a common limitation of many of these studies is the reliance on experienced sonographers to perform the ultrasound examination, thereby limiting the relevance of the findings to routine clinical practice [1,5,24].…”

Section: Discussionmentioning

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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“…Wang et al [ 43 ] reported that US scanning performed by single experienced anesthesiologist before neuraxial blockade significantly enhanced the first-attempt success rate. Another study published by Ekinci et al [ 44 ] demonstrated that the number of skin punctures was significantly decreased when using preprocedural US imaging, but total procedure time was comparable with the conventional spinal anesthesia technique. Our recent study conducted in patients with documented lumbar scoliosis or those with history of previous spinal surgery also showed similar results that the number of needle passes and puncture attempts were significantly lower in the US group than in the control group, but total procedure time was not significantly different between the two groups [ 13 ].…”

Section: Up-to-date Literature Reviewmentioning

confidence: 99%

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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The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks

Cited by 28 publications

References 13 publications

Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

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

Ultrasonography for lumbar neuraxial block

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