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Ultrasonography for neuraxial blocks: a review of the evidence.
Minerva Anestesiol. 2017 05; 83(5):512-523.MA

Abstract

INTRODUCTION

This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) pertaining to the use of adjunctive ultrasonography (US) for neuraxial blocks.

EVIDENCE ACQUISITION

The literature search was conducted using the MEDLINE, EMBASE and PUBMED databases. For the MEDLINE and EMBASE searches, the MESH terms "ultrasonography" and key word "ultrasound" were queried; using the operator "and", they were combined with the MESH terms "neuraxial block," "epidural anesthesia," "epidural analgesia," "spinal anesthesia," "spinal analgesia," "intrathecal anesthesia," "intrathecal analgesia," "caudal anesthesia," and "caudal analgesia." For the PUBMED search, the search terms "ultrasound neuraxial," "ultrasound intrathecal," "ultrasound epidural" (limited to clinical trials), "ultrasound spinal" (limited to clinical trials), and "ultrasound caudal" (limited to clinical trials) were queried. Seventeen RCTs were retained for analysis.

EVIDENCE SYNTHESIS

Compared to conventional palpation of landmarks, US assistance (i.e., preprocedural scanning) results in fewer needle passes/insertions and skin punctures for neuraxial blocks in obstetrical and surgical patients. These benefits seem most pronounced when expert operators carry out the sonographic exams and for patients displaying difficult spinal anatomy. Preliminary findings also suggest that US provides similar pain relief and functional improvement to fluoroscopy for epidural/caudal steroid injection in patients afflicted with chronic spinal pain. Although one trial demonstrated shorter needling time with US guidance (i.e., real-time scanning of needle advancement) compared to US assistance, these findings require further validation.

CONCLUSIONS

Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US for neuraxial blocks. Further well-designed RCTs are warranted.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Elgueta MF
Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, QC, Canada.
Duong S
Herzl Family Medicine Center, Jewish General Hospital, Montreal, QC, Canada.
Finlayson RJ
Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, QC, Canada.
Tran DQ
Department of Anesthesia, Montreal General Hospital, McGill University, Montreal, QC, Canada - de_tran@hotmail.com.

MeSH

Analgesia, EpiduralAnesthesia, ConductionAnesthesia, EpiduralAnesthesia, SpinalHumansRandomized Controlled Trials as TopicUltrasonography, Interventional

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27827521

Clinical Trial Links

Real-time Ultrasound Guidance for Thoracic Epidural Blocks

Citation

Elgueta, Maria F., et al. "Ultrasonography for Neuraxial Blocks: a Review of the Evidence." Minerva Anestesiologica, vol. 83, no. 5, 2017, pp. 512-523.
Elgueta MF, Duong S, Finlayson RJ, et al. Ultrasonography for neuraxial blocks: a review of the evidence. Minerva Anestesiol. 2017;83(5):512-523.
Elgueta, M. F., Duong, S., Finlayson, R. J., & Tran, D. Q. (2017). Ultrasonography for neuraxial blocks: a review of the evidence. Minerva Anestesiologica, 83(5), 512-523. https://doi.org/10.23736/S0375-9393.16.11650-5
Elgueta MF, et al. Ultrasonography for Neuraxial Blocks: a Review of the Evidence. Minerva Anestesiol. 2017;83(5):512-523. PubMed PMID: 27827521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasonography for neuraxial blocks: a review of the evidence. AU - Elgueta,Maria F, AU - Duong,Silvia, AU - Finlayson,Roderick J, AU - Tran,De Q, Y1 - 2016/11/09/ PY - 2016/11/9/pubmed PY - 2019/7/26/medline PY - 2016/11/10/entrez SP - 512 EP - 523 JF - Minerva anestesiologica JO - Minerva Anestesiol VL - 83 IS - 5 N2 - INTRODUCTION: This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) pertaining to the use of adjunctive ultrasonography (US) for neuraxial blocks. EVIDENCE ACQUISITION: The literature search was conducted using the MEDLINE, EMBASE and PUBMED databases. For the MEDLINE and EMBASE searches, the MESH terms "ultrasonography" and key word "ultrasound" were queried; using the operator "and", they were combined with the MESH terms "neuraxial block," "epidural anesthesia," "epidural analgesia," "spinal anesthesia," "spinal analgesia," "intrathecal anesthesia," "intrathecal analgesia," "caudal anesthesia," and "caudal analgesia." For the PUBMED search, the search terms "ultrasound neuraxial," "ultrasound intrathecal," "ultrasound epidural" (limited to clinical trials), "ultrasound spinal" (limited to clinical trials), and "ultrasound caudal" (limited to clinical trials) were queried. Seventeen RCTs were retained for analysis. EVIDENCE SYNTHESIS: Compared to conventional palpation of landmarks, US assistance (i.e., preprocedural scanning) results in fewer needle passes/insertions and skin punctures for neuraxial blocks in obstetrical and surgical patients. These benefits seem most pronounced when expert operators carry out the sonographic exams and for patients displaying difficult spinal anatomy. Preliminary findings also suggest that US provides similar pain relief and functional improvement to fluoroscopy for epidural/caudal steroid injection in patients afflicted with chronic spinal pain. Although one trial demonstrated shorter needling time with US guidance (i.e., real-time scanning of needle advancement) compared to US assistance, these findings require further validation. CONCLUSIONS: Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US for neuraxial blocks. Further well-designed RCTs are warranted. SN - 1827-1596 UR - https://www.unboundmedicine.com/medline/citation/27827521/Ultrasonography_for_neuraxial_blocks:_a_review_of_the_evidence_ DB - PRIME DP - Unbound Medicine ER -