Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period

Wilkes, Denise; Martinello, Caroline; Medeiros, Felipe A.; Babazade, Rovnat; Hurwitz, Erin E; Khanjee, Naveed; Iyer, Prashanth; Leary, Paul; Dhera, Rakesh B. Va

doi:10.23736/s0375-9393.17.11782-7

Cited by 7 publications

(8 citation statements)

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“…In eight trials, the indication for the neuraxial procedure was labour analgesia [17,18,23,28,29,32,35,37], in 13 trials, it was for elective caesarean section [16, 19-22, 24, 26, 27, 30, 31, 33, 34, 36], and in one trial, it was labour analgesia or elective caesarean section [25]. The neuraxial technique was combined spinalepidural [19,24,26,28,36], epidural [17,18,23,25,29,31,32,35,37] or spinal [16, 20-22, 27, 30, 33, 34] in five, nine and eight trials, respectively. In two trials, the neuraxial technique was predicted to be easy [16,17], whereas it was predicted to be difficult in seven trials [20,22,23,27,32,34,36] and heterogeneous in 10 trials [18, 19, 21, 28-31, 33, 35, 37].…”

Section: Resultsmentioning

confidence: 99%

“…Of the original 4978 unique records identified by our search strategy, 22 randomised controlled trials met the inclusion criteria [16–37]. Details of the screening process are shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The neuraxial technique was combined spinal‐epidural [19, 24, 26, 28, 36], epidural [17, 18, 23, 25, 29, 31, 32, 35, 37] or spinal [16, 20–22, 27, 30, 33, 34] in five, nine and eight trials, respectively. In two trials, the neuraxial technique was predicted to be easy [16, 17], whereas it was predicted to be difficult in seven trials [20, 22, 23, 27, 32, 34, 36] and heterogeneous in 10 trials [18, 19, 21, 28–31, 33, 35, 37]. Further, in one trial, preprocedural ultrasound was conducted before epidural catheterisation followed by the performance of spinal anaesthesia [31].…”

Section: Resultsmentioning

confidence: 99%

“…Characteristics of the trials are presented in Table 1. In eight trials, the indication for the neuraxial procedure was labour analgesia [17, 18, 23, 28, 29, 32, 35, 37], in 13 trials, it was for elective caesarean section [16, 19–22, 24, 26, 27, 30, 31, 33, 34, 36], and in one trial, it was labour analgesia or elective caesarean section [25]. The neuraxial technique was combined spinal‐epidural [19, 24, 26, 28, 36], epidural [17, 18, 23, 25, 29, 31, 32, 35, 37] or spinal [16, 20–22, 27, 30, 33, 34] in five, nine and eight trials, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Fifth, meta‐analysis of some outcomes, such as the need for three or more skin punctures and needle redirections, included fewer than four trials and/or less than 200 patients, leading to possible imprecision and unreliability [48]. Last, only one of the included trials was sufficiently powered to examine outcomes related to complications [37].…”

Section: Discussionmentioning

confidence: 99%

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Conventional landmark palpation vs. preprocedural ultrasound for neuraxial analgesia and anaesthesia in obstetrics – a systematic review and meta‐analysis with trial sequential analyses

2020

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The aim of this systematic review and meta-analysis was to examine the efficacy, time taken and the safety of neuraxial blockade performed for obstetric patients with the assistance of preprocedural ultrasound, in comparison with the landmark palpation method. The bibliographic databases Central, CINAHL, EMBASE, Global Health, MEDLINE, Scopus and Web of Science were searched from inception to 13 February 2020 for randomised controlled trials that included pregnant women having neuraxial procedures with preprocedural ultrasound as the intervention and conventional landmark palpation as the comparator. For continuous and dichotomous outcomes, respectively, we calculated the mean difference using the inverse-variance method and the risk ratio with the Mantel-Haenszel method. In all, 22 trials with 2462 patients were included. Confirmed by trial sequential analysis, preprocedural ultrasound increased the first-pass success rate by a risk ratio (95%CI) of 1.46 (1.16-1.82), p = 0.001 in 13 trials with 1253 patients. No evidence of a difference was found in the total time taken between preprocedural ultrasound and landmark palpation, with a mean difference (95%CI) of 50.1 (À13.7 to 113.94) s, p = 0.12 in eight trials with 709 patients. The quality of evidence was graded as low and very low, respectively, for these co-primary outcomes. Sub-group analysis underlined the increased benefit of preprocedural ultrasound for those in whom the neuraxial procedure was predicted to be difficult. Complications, including postpartum back pain and headache, were decreased with preprocedural ultrasound. The adoption of preprocedural ultrasound for neuraxial procedures in obstetrics is recommended and, in the opinion of the authors, should be considered as a standard of care, in view of its potential to increase efficacy and reduce complications without significant prolongation of the total time required.

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