Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)
Background and Aims Neuraxial anaesthesia is a common effective anaesthesia technique. Traditional palpation is the usual technique for detecting the vertebral interspace, but it has limitations. A novel hand-held ultrasound guidance device, Accuro, has been used recently. This systematic review and meta- analysis aimed to evaluate the efficacy and safety of ultrasound-guided neuraxial anaesthesia compared to traditional palpation in patients undergoing neuraxial anaesthesia.
Methods Randomized controlled trials were sought in six databases for a systematic review and meta-analysis. With a 95% confidence interval, a random- effects model calculated Risk Ratio or Mean Difference. Cochrane Risk of Bias tool assessed bias. Five RCTs were included, a total of 369 patients. This review was registered with PROSPERO with the identifying code CRD42023416937.
Results Five studies with a total of 369 patients met our criteria. The risk of bias in four studies was low and there was some concern in one study. First insertion success rate showed a favorable risk ratio for the Accuro compared to Palpation, the risk ratio was 1.44 [95% CI 1.01 – 2.05, P= 0.05], Accuro caused a significant reduction in needle skin passes[MD -0.63; 95% CI (-1.05; -0.21); p<0.01], while failing to demonstrate a significant reduction in needle redirection [MD -1.31 (95% CI: [-2.71; 0.11], p = 0.07)]. Procedure time was significantly shorter in palpation [MD 127.82; 95% CI (8.68; -– 246.97); p=0.04]
Conclusions Accuro is effective in reducing the number of trials needed to perform a successful insertion for spinal anesthesia and the results of our meta- analysis support the use of Accuro in clinical practice.
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