A randomised controlled trial comparing needle movements during combined spinal-epidural anaesthesia with and without ultrasound assistance

被引:59
作者
Chin, A. [1 ]
Crooke, B. [1 ]
Heywood, L. [1 ]
Brijball, R. [1 ]
Pelecanos, A. M. [2 ]
Abeypala, W. [1 ]
机构
[1] Royal Brisbane & Womens Hosp, Dept Anaesthesia & Perioperat Med, Brisbane, Qld, Australia
[2] QIMR Berghofer Med Res Inst, Stat Unit, Brisbane, Qld, Australia
关键词
anaesthesia: epidural; anaesthesia: obstetric; anaesthesia: spinal; caesarean section; ultrasound; PREGNANCY;
D O I
10.1111/anae.14206
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Ultrasound assistance for neuraxial techniques may improve technical performance; however, it is unclear which populations benefit most. Our study aimed to investigate the efficacy of neuraxial ultrasound in women having caesarean section with combined spinal-epidural anaesthesia, and to identify factors associated with improved technical performance. Two-hundred and eighteen women were randomly allocated to ultrasound-assisted or control groups. All the women had a pre-procedure ultrasound, but only women in the ultrasound group had this information conveyed to the anaesthetist. Primary outcomes were first-pass success (a single needle insertion with no redirections) and procedure difficulty. Secondary outcomes were block quality, patient experience and complications. Exploratory sub-group analysis and regression analysis were used to identify factors associated with success. Data from 215 women were analysed. First-pass success was achieved in 67 (63.8%) and 42 (38.2%) women in the ultrasound and control groups, respectively (adjusted p = 0.001). Combined spinal-epidural anaesthesia was difficult' in 19 (18.1%) and 33 (30.0%) women in the ultrasound and control groups, respectively (adjusted p = 0.09). Secondary outcomes did not differ significantly. Anaesthetists misidentified the intervertebral level by two or more spaces in 23 (10.7%) women. Sub-group analysis demonstrated a benefit for ultrasound in women with easily palpable spinous processes (adjusted p = 0.027). Regression analysis identified use of ultrasound and easily palpable spinous processes to be associated with first-pass success.
引用
收藏
页码:466 / 473
页数:8
相关论文
共 22 条
[1]   Ultrasound-guided intrathecal anesthesia: Does scanning help? [J].
Abdelhamid, Sherif A. ;
Mansour, Magdy A. .
EGYPTIAN JOURNAL OF ANAESTHESIA, 2013, 29 (04) :389-394
[2]   Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? [J].
Ansari, T. ;
Yousef, A. ;
El Gamassy, A. ;
Fayez, M. .
INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 2014, 23 (03) :213-216
[3]   Spinal ultrasound versus palpation for epidural catheter insertion in labour A randomised controlled trial [J].
Arzola, Cristian ;
Mikhael, Rafeek ;
Margarido, Clarita ;
Carvalho, Jose C. A. .
EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2015, 32 (07) :499-505
[4]  
Benjamini Y, 2001, ANN STAT, V29, P1165
[5]   Ability of anaesthetists to identify a marked lumbar interspace [J].
Broadbent, CR ;
Maxwell, WB ;
Ferrie, R ;
Wilson, DJ ;
Gawne-Cain, M ;
Russell, R .
ANAESTHESIA, 2000, 55 (11) :1122-1126
[6]   Ultrasound Imaging Facilitates Spinal Anesthesia in Adults with Difficult Surface Anatomic Landmarks [J].
Chin, Ki Jinn ;
Perlas, Anahi ;
Chan, Vincent ;
Brown-Shreves, Danielle ;
Koshkin, Arkadiy ;
Vaishnav, Vandana .
ANESTHESIOLOGY, 2011, 115 (01) :94-101
[7]   Ultrasonography of the Adult Thoracic and Lumbar Spine for Central Neuraxial Blockade [J].
Chin, Ki Jinn ;
Karmakar, Manoj Kumar ;
Peng, Philip .
ANESTHESIOLOGY, 2011, 114 (06) :1459-1485
[8]   Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists [J].
Cook, T. M. ;
Counsell, D. ;
Wildsmith, J. A. W. .
BRITISH JOURNAL OF ANAESTHESIA, 2009, 102 (02) :179-190
[9]  
Grau T, 2003, CAN J ANAESTH, V50, P1047, DOI 10.1007/BF03018371
[10]   Efficacy of ultrasound imaging in obstetric epidural anesthesia [J].
Grau, T ;
Leipold, RW ;
Conradi, R ;
Martin, E ;
Motsch, J .
JOURNAL OF CLINICAL ANESTHESIA, 2002, 14 (03) :169-175