Skip to main content

Advertisement

SpringerLink
Log in

Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials

  • Review Article
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Neuraxial anesthesia is a common practice in obstetrics. Evidence suggests that preprocedural ultrasound versus the conventional landmark location method accurately identifies a given intervertebral space and predicts the needle insertion depth required to reach the spinal canal. However, whether the preprocedural ultrasound examination improves the first-pass success (FPS) rate remains elusive. Major databases were systematically searched for all relevant studies published in English up to June 2019. Eighteen randomized controlled trials including 1844 patients were enrolled. The quality of eligible studies was assessed, and predefined outcomes were synthesized by meta-analysis. The primary results showed that preprocedural ultrasound increased the FPS rate in patients with predicted puncture difficulty but not in patients who were easily punctured. Preprocedural ultrasound reduced the number of redirections and punctures and decreased the incidence of vascular puncture and backache. There was no evidence of a reduction in failed punctures. We also noted that preprocedural ultrasound prolonged the identification time but not the procedure time. Thus, this systematic review provides evidence that preprocedural ultrasound does not improve the FPS rate of neuraxial anesthesia in patients who are easily palpated, although it increases the FPS rate in patients who are difficult to palpate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Srinivasan KK, Iohom G, Loughnane F, Lee PJ. Conventional landmark-guided midline versus preprocedure ultrasound-guided paramedian techniques in spinal anesthesia. Anesth Analg. 2015;121:1089–96.

    Article  Google Scholar 

  2. Perlas A, Chaparro LE, Chin KJ. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg Anesth Pain Med. 2016;41:251–60.

    Article  Google Scholar 

  3. Shaikh F, Brzezinski J, Alexander S, Arzola C, Carvalho JC, Beyene J, Sung L. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta analysis. BMJ. 2013;346:f1720–31.

    Article  Google Scholar 

  4. Elsharkawy H, Maheshwari A, Babazade R, Perlas A, Zaky S, Mounir-Soliman L. Real-time ultrasound-guided spinal anesthesia in patients with predicted difficult anatomy. Minerva Anestesiol. 2017;83:465–73.

    PubMed  Google Scholar 

  5. Arzola C, Mikhael R, Margarido C, Carvalho JC. Spinal ultrasound versus palpation for epidural catheter insertion in labour: a randomised controlled trial. Eur J Anaesthesiol. 2015;32:499–505.

    Article  Google Scholar 

  6. Ansari T, Yousef A, El Gamassy A, Fayez M. Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth. 2014;23:213–16.

    Article  Google Scholar 

  7.  Srinivasan KK, Leo AM, Iohom G, Loughnane F, Lee PJ. Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5-S1: is this better than landmark-guided midline approach? A randomised controlled trial. Indian J Anaesth. 2018;62:53–60.

    Article  CAS  Google Scholar 

  8. Tawfik MM, Atallah MM, Elkharboutly WS, Allakkany NS, Abdelkhalek M. Does preprocedural ultrasound increase the first-pass success rate of epidural catheterization before cesarean delivery? A randomized controlled trial. Anesth Analg. 2017;124:851–56.

    Article  Google Scholar 

  9. Creaney M, Mullane D, Casby C, Tan T. Ultrasound to identify the lumbar space in women with impalpable bony landmarks presenting for elective caesarean delivery under spinal anaesthesia: a randomised trial. Int J Obstet Anesth. 2016;28:12–6.

    Article  CAS  Google Scholar 

  10. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med. 2001;26:64–7.

    Article  CAS  Google Scholar 

  11. Qian W, Cheng Y, Tian-Long W. Ultrasound facilitates identification of combined spinal-epidural puncture in obese parturients. Chin Med J (Engl). 2012;125:3840–3.

    Article  Google Scholar 

  12. Grau T, Leipold RW, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 2001;45:766–71.

    Article  Google Scholar 

  13. Ekinci M, Alici HA, Ahiskalioglu A, Ince I, Aksoy M, Celik EC, Dostbil A, Celik M, Baysal PK, Golboyu BE, Yeksan AN. The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks. J Clin Anesth. 2017;37:82–5.

    Article  CAS  Google Scholar 

  14. Grau T, Leipold RW, Fatehi S, Martin E, Motsch J. Real-time ultrasonic observation of combined spinal-epidural anaesthesia. Eur J Anaesthesiol. 2004;21:25–31.

    Article  Google Scholar 

  15. Abdelazim IA. Pre-puncture ultrasound guided epidural insertion before vaginal delivery. J Clin Monit Comput. 2015;29:573–7.

    Article  Google Scholar 

  16. Turkstra TP, Marmai KL, Armstrong KP, Kumar K, Singh SI. Preprocedural ultrasound assessment does not improve trainee performance of spinal anesthesia for obstetrical patients: a randomized controlled trial. J Clin Anesth. 2017;37:21–4.

    Article  CAS  Google Scholar 

  17. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169–75.

    Article  Google Scholar 

  18. Urfalioglu AB, Lal B, Oksuz G, Bakacak M, Boran OF, Oksuz H. Comparison of the landmark and ultrasound methods in cesarean sections performed under spinal anesthesia on obese pregnants. J Matern Fetal Neonatal Med. 2017;30:1051–6.

    Article  CAS  Google Scholar 

  19. Dhanger S, Vinayagam S, Vaidhyanathan B, Rajesh IJ, Tripathy DK. Comparison of landmark versus pre-procedural ultrasonography-assisted midline approach for identification of subarachnoid space in elective caesarean section: a randomised controlled trial. Indian J Anaesth. 2018;62:280–4.

    Google Scholar 

  20. Perna P, Gioia A, Ragazzi R, Volta CA, Innamorato M. Can pre-procedure neuroaxial ultrasound improve the identification of the potential epidural space when compared with anatomical landmarks? A prospective randomized study. Minerva Anestesiol. 2017;83:41–9.

    CAS  PubMed  Google Scholar 

  21. Sahin T, Balaban O, Sahin L, Solak M, Toker K. A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients. J Anesth. 2014;28:413–9.

    Article  CAS  Google Scholar 

  22. Chin A, Crooke B, Heywood L, Brijball R, Pelecanos AM, Abeypala W. A randomised controlled trial comparing needle movements during combined spinal-epidural anaesthesia with and without ultrasound assistance. Anaesthesia. 2018;73:466–73.

    Article  Google Scholar 

  23. Li M, Ni X, Xu Z, Shen F, Song Y, Li Q, Liu Z, Li M, Ni X, Xu Z, et al. Ultrasound-assisted technology versus the conventional landmark location method in spinal anesthesia for cesarean delivery in obese parturients: a randomized controlled trial. Anesth Analg. 2019;129:155–61.

    PubMed  Google Scholar 

  24. Cork RC, Kryc JJ, Vaughan RW. Ultrasonic localization of the lumbar epidural space. Anesthesiology. 1980;52:513–6.

    Article  CAS  Google Scholar 

  25. Chong SE, Mohd Nikman A, Saedah A, Wan Mohd Nazaruddin WH, Kueh YC, Lim JA, Shamsul Kamalrujan H. Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass. Br J Anaesth. 2017;118:799–801.

    Article  CAS  Google Scholar 

  26. Darrieutort-Laffite C, Bart G, Planche L, Glemarec J, Maugars Y, Le Goff B. Usefulness of a pre-procedure ultrasound scanning of the lumbar spine before epidural injection in patients with a presumed difficult puncture: a randomized controlled trial. Jt Bone Spine. 2015;82:356–61.

    Article  Google Scholar 

  27. Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011;115:94–101.

    Article  Google Scholar 

  28. Brodsky JB, Mariano ER. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anaesthesiol. 2011;25:61–72.

    Article  CAS  Google Scholar 

  29. Chin KJ, Ramlogan R, Arzola C, Singh M, Chan V. The utility of ultrasound imaging in predicting ease of performance of spinal anesthesia in an orthopedic patient population. Reg Anesth Pain Med. 2013;38:34–8.

    Article  Google Scholar 

  30. Rakhi K, Sonal R, Neha D, Chakraborty A, Sinha S. Comparison of ultrasound imaging in transverse median and parasagittal oblique planes for thoracic epidurals: a pilot study. Indian J Anaesth. 2016;60:377–81.

    Article  Google Scholar 

Download references

Funding

This work was funded by the Research Foundation of Technology Bureau of Anhui Province, China (Grant No. 201904a07020026).

Author information

Authors and Affiliations

  1. Department of Anaesthesia, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China

    Lianxiang Jiang, Fang Zhang, Jingjing Lv, Wei Chen & Zeping Dai

  2. Department of Emergency Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China

    Na Wei

Authors
  1. Lianxiang Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Na Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jingjing Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zeping Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zeping Dai.

Ethics declarations

Conflict of interest

All authors have no conflicts of interest in this review.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, L., Zhang, F., Wei, N. et al. Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials. J Anesth 34, 434–444 (2020). https://doi.org/10.1007/s00540-020-02750-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-020-02750-6

Keywords

Search

Navigation