Discussion
neuraxial anesthesiaOur
BLIND, COMPLICATIONS
In this randomized controlled trial, we found no significant difference in procedural time for CSE analgesia between the handheld ultrasound-assisted and landmark-guided techniques. However, the use of handheld ultrasound demonstrated better results in terms of the performance time, the epidural success rate at the first puncture attempt, and the number of insertion attempts.To our best knowledge, this is the first study to compare handheld ultrasound assistance with conventional landmark palpation for CSE analgesia in laboring women. The use of handheld ultrasound can be beneficial in the clinical setting of labor CSE analgesia, which is typically performed on demand at a maternity unit separate from the main operating theater. The time and effort required for ultrasound preparation can be minimized by using a portable handheld device instead of a console machine. Furthermore, the Accuro device does not require much expertise compared to a laptop or console-type ultrasound, as it is equipped with an algorithm that automatically recognizes neuraxial structures. Our results suggested that anesthetic providers might consider using handheld ultrasound in labor CSE analgesia owing to its equivalent total time but a shorter performance time and a smaller number of puncture attempts.We chose the procedural time as the primary outcome of this study because we considered that it could be one of the most important determinant of the first choice for neuraxial technique in clinical practiceFailure to obtain CSF on the first spinal attempt during the NTN technique may be attributed to incorrect placement or excessive paramedian deviation of the epidural needleA high correlation between the depth measured by console ultrasound and actual needle depth was reportedTheoretically, the use of preprocedural ultrasound has potential to reduce the complications of neuraxial anesthesiaOur study had limitations. First, we could not blind the performer to the group allocations because of the nature of the study. Further studies using blinded techniques are required. Second, this study was conducted in healthy pregnant women with relatively low body mass index. Although we performed an exploratory subgroup analysis of mothers with a body mass index > 30 mg/mIn conclusion, we observed no significant difference in the total procedure time between handheld ultrasound assistance and landmark palpation in the CSE technique in mothers receiving labor analgesia. However, the use of preprocedural handheld ultrasound resulted in a reduction in the performance time and an improvement in the first-attempt success rate. These findings indicate that handheld ultrasound may be a valuable option for labor CSE analgesia. Future studies in mothers with predictors of technical difficulty with procedures performed by inexperienced anesthesiologists, such as trainees and resident anesthesiologists, are required.