Background and Aims Ultrasound-guided central neuraxial blockade (CNB) has been shown to reduce the number of insertion attempts in high BMI parturients.[1] The objective of this project was to gather data on our CNB practice for BMI >40 parturients at a busy UK obstetric unit.

Methods An online data collection form was used to identify the type of CNB undertaken, BMI, use of pre-procedural ultrasound, number of intervertebral spaces used, number of skin punctures made, number of re-angulations, use of a second operator, success rate and time taken for spinals.

Results Over a period of 7 weeks, 31 CNBs were performed in parturients with BMI>40. 23 CNBs were undertaken without the use of pre-procedural ultrasound, whereas 8 used ultrasound beforehand. In the ultrasound group, a median of 1 intervertebral space was used, 1 skin puncture was made, 1 re-angulation occurred, a second operator was never needed, all CNBs were ultimately successful and the mean time for spinals was 2.13 minutes. This compares to the non-ultrasound group, where a median of 1 intervertebral space was used, 2 skin punctures were made, 3 re-angulations occurred, a second operator was used twice, two CNBs (both epidurals) were ultimately unsuccessful and the mean time for spinals was 5.67 minutes.

Conclusions The use of pre-procedural ultrasound in BMI >40 parturients results in quantitatively more successful CNBs. The time taken for spinals, in particular, reduced by more than half (with a mean time-saving of over 2.5 minutes per spinal) which could make a significant difference to clinical outcome in emergency caesarean sections.