• Anesthesia, Conduction
• REGIONAL ANESTHESIA
• Ultrasonography

• epidural anaesthesia
• lumbar puncture
• network meta-analysis
• spinal anaesthesia
• ultrasound

• Humans
• Ultrasonography, Interventional/methods
• Anatomic Landmarks
• Adult
• Network Meta-Analysis
• Randomized Controlled Trials as Topic
• Spinal Puncture/methods
• Punctures/methods
• Patient Satisfaction

• Obstetrics
• REGIONAL ANESTHESIA
• Ultrasonography

• Pregnancy
• Female
• Humans
• Anesthesia, Spinal/methods
• Ultrasonography, Interventional/methods
• Spinal Puncture/methods
• Ultrasonography
• Obesity/complications
• Obesity/diagnosis
• Palpation

• randomized controlled trials
• anatomy
• health care
• medical research

• Pregnancy
• Humans
• Female
• Ultrasonography, Interventional/methods
• Anesthesia, Spinal/methods
• Spinal Puncture
• Analgesia, Epidural/methods
• Palpation

• Neuraxial anesthesia
• Pregnancy
• Regional anesthesia
• handheld ultrasound
• portable ultrasound
• ultrasound guided neuraxial anesthesia

• Adult anaesthesia
• Adult surgery
• Ultrasonography

• Humans
• Aged
• Network Meta-Analysis
• Spinal Puncture
• Anesthesia, Epidural/methods
• Lumbar Vertebrae
• Ultrasonography, Interventional/methods

• the Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine

• Humans
• Augmented Reality
• Epidural Space/diagnostic imaging
• Phantoms, Imaging
• Punctures/methods

• Epidural space
• labor analgesia
• preprocedural ultrasonography

• Analgesia
• Intercostal
• Pain
• Paravertebral
• Quadratus Lumborum
• Robotic Urologic Surgery
• Tranvsersus Abdominis Plane
• Urology

• lumbar
• preprocedural
• ultrasound

• Cesarean
• Insertion attempts
• Obese
• Spinal
• Ultrasound

• Anesthesia, Spinal/methods
• Cesarean Section/methods
• Female
• Humans
• Obesity/complications
• Palpation/methods
• Pregnancy
• Ultrasonography, Interventional/methods

Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound.

One hundred obese patients (BMI ≥ 30 kg/m²) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First-attempt success rate, the median positioning time and total operation time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, anesthesia adverse reactions, complications after anesthesia, and patients’ satisfaction with the epidural puncture were recorded.

The first-attempt success rate was significantly different between the two groups [92% (46/50) vs. 76% (38/50), P  =  0.029]. The median positioning time and total operation time in the paramedian approach group were higher than those in the median approach group (227.7 s vs. 201.6 s, P  =  0.037; 251.3 s vs. 247.4 s, P  =  0.145). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs. 12%, P  =  0.026), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P  =  0.032).

The ultrasound-guided paramedian approach for CSEA is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction.

Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019

• Cesarean delivery
• Combined spinal epidural anesthesia
• Different approaches
• Obese patients
• Ultrasound

For parturients with paroxysmal uterine contraction pain, rapid analgesia is needed. We used preprocedure ultrasound imaging combined with the palpation technique in epidural analgesia for labor, and evaluated the usefulness of this technique in epidural labor analgesia.

To evaluate the usefulness of preprocedure ultrasound imaging in epidural analgesia for labor.

In this prospective randomized observational study, 72 parturients were assigned to two groups (combined or palpation group). The target interspace of all parturients was first identified by the palpation technique. Then in the combined group, preprocedure ultrasound imaging was used before epidural puncture. In the palpation group, only the traditional anatomical landmarks technique (palpation technique) was performed. The primary outcome was total duration of the epidural procedure (for the ultrasound group, the duration of the preprocedure ultrasound imaging was included). The secondary outcomes were the number of skin punctures, the success rate at first needle pass, the number of needle passes, the depth from the skin to epidural space, and the complications of the procedure.

Total duration of the epidural procedure was similar between the two groups (406.5 ± 92.15 s in the combined group and 380.03 ± 128.2 s in the palpation group; P = 0.318). A significant improvement was demonstrated for epidural puncture and catheterization in the combined group. The number of needle passes was 1.14 in the combined group and 1.72 in the palpation group (P = 0.001). The number of skin puncture sites was 1.20 in the combined group and 1.25 in the palpation group (P = 0.398). The success rate at first needle pass was 88.89% in the combined group and 66.67% in the palpation group (P = 0.045).

This study demonstrated that the total duration of epidural procedures with preprocedure ultrasound imaging combined with the palpation technique was not longer than the traditional anatomical landmarks technique, which were performed by six experienced anesthesiologists in parturients with normal weights undergoing labor analgesia.

• Preprocedure ultrasound imaging
• Epidural puncture
• Epidural catheterization
• Palpation technique
• Labor analgesia

Spinal anesthesia is the regional technique preferred for cesarean section and is usually administered using the traditional landmark technique. Ultrasonography of the spine appears to be helpful in locating the puncture site and increasing the success rate. The primary objective of this study was to assess the use of ultrasonogram in locating the lumbar interspinous space for spinal anesthesia in laboring parturients brought for elective cesarean section.

Sixty parturients scheduled to undergo elective cesarean section under spinal anesthesia were included in this prospective randomized controlled trial, after obtaining the institutional ethical clearance. In Group I, 30 patients received spinal anesthesia by landmark technique and in Group II, 30 patients underwent ultrasound-guided spinal anesthesia. The statistical analysis was done using SPSS software version 17 (SPSS Inc., Chicago, Illinois, USA) for Microsoft windows.

The time taken for spinal in Group I was longer than in Group II (62 ± 18s; 41 ± 11s; P = 0.0001). The number of attempts of needle insertion was significantly less in Group II (group I 1.86 ± 1.04: group II 1.06 ± 0.25). However, the total preparation time (28 8.30 ± 92 vs 804.73 ± 77; P = 0.0001) was more in the ultrasound-guided than in the landmark group. The patients had better satisfaction in group II.

Preprocedural ultrasound is a useful tool for successful lumbar puncture in parturients as it minimizes the number of attempts of needle insertion and provides better patient satisfaction.

• Cesarean section
• LSCS
• USG
• landmark technique
• spinal anesthesia
• subarachnoid block

• acute lymphoblastic leukemia
• lumbar puncture
• radiology
• supportive care

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

• analgesia
• anesthesia
• epidural
• lumbar
• neuraxial
• space
• spinal
• ultrasound

• Anesthesia
• geriatrics
• spinal
• ultrasound imaging

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.

• Anesthesia, epidural
• Anesthesia, spinal
• Lumbar vertebrae
• Ultrasonography

• epidural analgesia
• landmark palpation
• obstetric
• spinal anaesthesia
• ultrasound

• Neuraxial
• device design
• force-sensing resistor

• Neuraxial anesthesia
• Obstetric neuraxial blockade
• Ultrasound

• Neuraxial anesthesia
• Obstetrics
• Ultrasound

• Neuraxial block
• Spine
• Ultrasound imaging

• Analgesia
• Anesthesia
• Epidural
• Labor
• Morbid
• Obesity
• Obstetric
• Ultrasound

This study evaluated the efficacy of spinal anesthesia administration by resident physicians when using an ultrasound system with automated neuraxial landmark detection capabilities.

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.

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/m², 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).

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.

• Bone-specific imaging
• Neuraxial ultrasound
• Spinal anesthesia

• Lumbar ultrasonography
• neuraxial block
• obstetric anesthesia

• analgesia
• anesthesiology
• epidural
• labor
• midline
• ultrasound

• Adult
• Analgesia, Epidural/instrumentation
• Analgesia, Epidural/methods
• Analgesics/administration & dosage
• Cohort Studies
• Epidural Space/diagnostic imaging
• Female
• Humans
• Pregnancy
• Prospective Studies
• Treatment Outcome
• Ultrasonography, Interventional/methods

• central neuraxial block
• continuous epidural infusion
• continuous spinal anaesthesia
• epidural analgesia
• labour analgesia
• patient-controlled epidural analgesia
• programmed intermittent epidural boluses
• ultrasound guidance

• anaesthesia techniques: first stage labour
• epidural anatomy
• labour pain: regional blocks

Ultrasound imaging before neuraxial blocks was reported to improve the ease of insertion and minimize the traumatic trials. However, the data about the use of ultrasound in thoracic epidural block are scanty. In this study, pre-insertion ultrasound scanning was compared to traditional manual palpation technique for insertion of the thoracic epidural catheter in abdominal operations.

Forty-eight patients scheduled to midline laparotomy under combined general anesthesia with thoracic epidural analgesia were included in the study. Patients were divided into two groups with regard to technique of epidural catheter insertion; ultrasound group (done ultrasound screening to determine the needle insertion point, angle of insertion, and depth of epidural space) and manual palpation group (used the traditional manual palpation technique). Number of puncture attempts, number of puncture levels, and number of needle redirection attempts were reported. Time of catheter insertion and complications were also reported in both groups.

Ultrasound group showed lower number of puncture attempts (1 [1, 1.25] vs. 1.5 [1, 2.75], P = 0.008), puncture levels (1 (1, 1) vs. 1 [1, 2], P = 0.002), and needle redirection attempts (0 [0, 2.25] vs. 3.5 [2, 5], P = 0.00). Ultrasound-guided group showed shorter time for catheter insertion compared to manual palpation group (140 ± 24 s vs. 213 ± 71 s P = 0.00).

Preprocedural ultrasound imaging increased the incidence of first pass success in thoracic epidural catheter insertion and reduced the catheter insertion time compared to manual palpation method.

• Laparotomy
• thoracic epidural
• ultrasound