Background and Aims Central Neuraxial Blocks (CNBs) are key to obstetric anaesthetic practice. They are performed by landmark technique, however, there is increasing evidence supporting the use of ultrasound-assisted CNBs1, 2.
This survey aims to explore:
Current use of ultrasound-assisted CNBs
Current training being delivered
Barriers to training
Methods We conducted an OAA-approved national survey of UK obstetric anaesthetists in 2021, with 394 completed responses.
Results 86% of responders were consultant obstetric anaesthetists. 69% said they perform ultrasound-assisted CNBs, but some only in specific circumstances (Figure 1). 40% do not use ultrasound at all due to lack of training or lack of confidence in the technique.
Midline and depth to posterior complex are seen as the primary landmarks to establish on ultrasound (Figure 2).
Perceived reasons why ultrasound might not be used are shown in Figure 3.
Only 9% of departments have guidelines for ultrasound-assisted CNBs.
Conclusions Ultrasound-assisted CNBs in obstetric anaesthesia remains a divisive subject, despite evidence suggesting it is a low-skill technique with improved first-pass success, without adding excessive time.
40% of responders do not use ultrasound due to lack of training and confidence in the technique and fears that overreliance on ultrasound may lead to deskilling in landmark techniques.
Time pressures, lack of trainers and uncertainty of benefits are the main barriers to implementing training.
For ultrasound-assisted CNB to gain more acceptance, we suggest:
Recognising neuraxial ultrasound as a key skill
Further guidance and training from the OAA or other regional anaesthesia course providers
Teaching and competency achievements must be embedded into training