• Xiu Ni, Meng-Zhu Li, Shuang-Qiong Zhou, Zhen-Dong Xu, Yue-Qi Zhang, Yi-Bing Yu, Jing Su, Li-Min Zhang, and Zhi-Qiang Liu.
• Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China.
• J Anesth. 2021 Aug 1; 35 (4): 475-482.

PurposeRecently, a new handheld ultrasound-based device, called Accuro, has been commercialized with a real-time automated interpretation of lumbar ultrasound images. We hypothesized that the handheld ultrasound device would improve the efficacy and safety of combined spinal-epidural anesthesia (CSEA) for cesarean delivery in obese parturients.MethodsEighty parturients with a body mass index > 30 kg∙m-2 scheduled for elective cesarean delivery were randomly allocated equally (palpation group and ultrasound group). The primary outcome was the first insertion success rate. Secondary outcomes were the time taken to identify the needle puncture site, duration of CSEA procedure, the total time, the rate of parturients who require needle redirections, the number of skin punctures, changes in the intended interspace, and the incidence of complications.ResultsCompared to the palpation group, the first insertion success rate was significantly higher (72.5% vs. 40.0%; P = 0.003), and time taken to identify the needle puncture site was less (30 [26-36] vs. 39 [32-49] seconds; P = 0.001) in the ultrasound group. The rate of parturients who required needle redirections (40.0% vs. 72.5%; P = 0.003) and the incidence of paresthesia were both lower (7.5% vs. 45.0%; P < 0.001). The other outcomes had no significant difference between groups. The mean difference between the epidural depth measured by the handheld ultrasound and needle depth was - 0.29 cm [95% limit of agreement, - 0.52 to - 0.05].ConclusionsOur study suggests using the Accuro ultrasound device can enhance the efficacy and safety of CSEA in obese parturients when executed by experienced anesthesiologists, and its automated estimation of epidural depth is accurate.© 2021. Japanese Society of Anesthesiologists.

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