Background and Aims Ultrasound-guided central neuraxial blockade (CNB) has been shown to reduce the number of insertion attempts in high BMI parturients. 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.
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