Ultrasonography for lumbar neuraxial block

Yoo, Seokha; Kim, Young‐Won; Park, Sun-Kyung; Ji, Sang‐Hwan; Kim, Jin‐Tae

doi:10.17085/apm.20065

Cited by 16 publications

(11 citation statements)

References 47 publications

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“…Once an approach is decided, the needle insertion site can be determined. Palpation has traditionally been used to identify anatomical landmarks that facilitate proper insertion; however, ultrasound guidance is becoming more frequently used to directly visualize intervertebral spaces and the associated needle insertion point, depth, and angle in real-time preprocedural ( 36 ). While some studies have shown superior accuracy or ease of needle placement assisted by newer techniques involving ultrasound, it remains controversial as others have shown no clear advantage ( 37 , 38 ).…”

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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Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…Several studies have shown that ultrasonography can help with spinal anesthesia in patients with difficult anatomy such as severe obesity, lumbar scoliosis, ankylosing spondylitis, and post-lumbar spine surgery. [ 7 ] However, there have been few reports on the anatomical changes in lumbar subcutaneous fat, and no reports were found of these changes being noted on pre-procedure ultrasonography. We call this structure the back fat slope.…”

Section: Discussionmentioning

confidence: 99%

The lumbar subcutaneous fat gradient in spinal anesthesia seen for morbidly obese patient with pre-procedure ultrasonography – A case report

Nakamura

Hisago²,

Ishitsuka³

2023

Saudi J Anaesth

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It has been reported that pre-procedure ultrasonography rises the success rate of spinal anesthesia in obese patients. In this article, we performed spinal anesthesia for morbidly obese patient with pre-procedure ultrasonography. And recognizing the lumbar subcutaneous fat gradient in morbidly obese patient was the key to success. A cesarean section was scheduled for a primigravida in her 30 s with BMI 61 kg/m2. The lumbar spine was not palpable. Pre-procedure ultrasonography revealed lumbar subcutaneous tissue getting thicker caudally in the sagittal view. Considering this fact, we adjusted the puncture site and succeeded. Postoperative complications were not observed. The pre-procedure ultrasonography is effective even in morbidly obese patients. It is important to recognize the lumbar subcutaneous fat gradient, the so-called back fat slope, for spinal anesthesia in obese patients.

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“…This technique is even more helpful when applied in those cases with anticipated difficulty, including anatomical alteration of the lumbar spine and a body mass index (BMI) > 33 kg/m 2 [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Artificial intelligence enhanced ultrasound (AI-US) in a severe obese parturient: a case report

et al. 2022

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Background Neuraxial anesthesia in obese parturients can be challenging due to anatomical and physiological modifications secondary to pregnancy; this led to growing popularity of spine ultrasound in this population for easing landmark identification and procedure execution. Integration of Artificial Intelligence with ultrasound (AI-US) for image enhancement and analysis has increased clinicians' ability to localize vertebral structures in patients with challenging anatomical conformation. Case presentation We present the case of a parturient with extremely severe obesity, with a Body Mass Index (BMI) = 64.5 kg/m2, in which the AI-Enabled Image Recognition allowed a successful placing of an epidural catheter. Conclusions Benefits gained from AI-US implementation are multiple: immediate recognition of anatomical structures leads to increased first-attempt success rate, making easier the process of spinal anesthesia execution compared to traditional palpation methods, reducing needle placement time for spinal anesthesia and predicting best needle direction and target structure depth in peridural anesthesia.

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Ultrasonography for lumbar neuraxial block

Cited by 16 publications

References 47 publications

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

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

The lumbar subcutaneous fat gradient in spinal anesthesia seen for morbidly obese patient with pre-procedure ultrasonography – A case report

Artificial intelligence enhanced ultrasound (AI-US) in a severe obese parturient: a case report

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