Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review
Abstract Background and Aims Preprocedural ultrasound (PPU) reduces the risk of technical failure in non‐obese patients and when technical difficulty is predicted. We conducted this review to determine if PPU improves first‐pass needle insertion success for neuraxial anesthesia in patients with obes...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-11-01
|
| Series: | Health Science Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/hsr2.70039 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846151698012176384 |
|---|---|
| author | Aaron K. Khoo Annie Huynh Anita Pelecanos Victoria A. Eley |
| author_facet | Aaron K. Khoo Annie Huynh Anita Pelecanos Victoria A. Eley |
| author_sort | Aaron K. Khoo |
| collection | DOAJ |
| description | Abstract Background and Aims Preprocedural ultrasound (PPU) reduces the risk of technical failure in non‐obese patients and when technical difficulty is predicted. We conducted this review to determine if PPU improves first‐pass needle insertion success for neuraxial anesthesia in patients with obesity. Methods We conducted a systematic review without meta‐analysis, due to the small number of included studies. The study protocol was registered (PROSPERO: CRD42022368271). We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library from January 1, 1980 to October 1, 2022 for peer‐reviewed randomized controlled or observational studies comparing PPU versus landmark techniques in patients with body mass index >30 kg/m2. The quality of evidence was assessed using the revised Cochrane risk‐of‐bias tool for randomized trials and Grading of Recommendations Assessment, Development, and Evaluation approach. Results There were nine randomized controlled studies, comprising 866 patients having lumbo‐sacral neuraxial techniques. Three studies utilized a small handheld ultrasound device called Accuro™ and six utilized non‐handheld ultrasound devices. Certainty of evidence was low for improving the first‐pass success rate. There was evidence (moderate certainty) that PPU decreased number of passes, increased first insertion attempt success, and reduced number of insertion attempts. There was no evidence that PPU affected identifying time, needling time, or overall procedural time. There was no evidence that PPU influenced procedural failure rate (very low certainty evidence) and insufficient evidence to suggest that artificial intelligence‐supported handheld devices were superior to conventional ultrasound devices. Conclusions In patients with obesity, there is evidence of very‐low to moderate certainty that PPU improves markers of insertion success, with no indication of increased adverse effects. PPU should be used to reduce attempts. Further studies adhering to standardized outcome definitions are required for definitive recommendations. Registration The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022368271). |
| format | Article |
| id | doaj-art-8310b2bae8b24008b84992221c4b6817 |
| institution | Kabale University |
| issn | 2398-8835 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Health Science Reports |
| spelling | doaj-art-8310b2bae8b24008b84992221c4b68172024-11-27T05:20:44ZengWileyHealth Science Reports2398-88352024-11-01711n/an/a10.1002/hsr2.70039Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic reviewAaron K. Khoo0Annie Huynh1Anita Pelecanos2Victoria A. Eley3School of Medicine Western Sydney University Sydney New South Wales AustraliaSchool of Medicine Western Sydney University Sydney New South Wales AustraliaQIMR Berghofer Brisbane Queensland AustraliaDepartment of Anaesthesia and Perioperative Medicine Royal Brisbane and Women's Hospital Brisbane Queensland AustraliaAbstract Background and Aims Preprocedural ultrasound (PPU) reduces the risk of technical failure in non‐obese patients and when technical difficulty is predicted. We conducted this review to determine if PPU improves first‐pass needle insertion success for neuraxial anesthesia in patients with obesity. Methods We conducted a systematic review without meta‐analysis, due to the small number of included studies. The study protocol was registered (PROSPERO: CRD42022368271). We conducted searches in MEDLINE, Embase, PubMed, and Cochrane Library from January 1, 1980 to October 1, 2022 for peer‐reviewed randomized controlled or observational studies comparing PPU versus landmark techniques in patients with body mass index >30 kg/m2. The quality of evidence was assessed using the revised Cochrane risk‐of‐bias tool for randomized trials and Grading of Recommendations Assessment, Development, and Evaluation approach. Results There were nine randomized controlled studies, comprising 866 patients having lumbo‐sacral neuraxial techniques. Three studies utilized a small handheld ultrasound device called Accuro™ and six utilized non‐handheld ultrasound devices. Certainty of evidence was low for improving the first‐pass success rate. There was evidence (moderate certainty) that PPU decreased number of passes, increased first insertion attempt success, and reduced number of insertion attempts. There was no evidence that PPU affected identifying time, needling time, or overall procedural time. There was no evidence that PPU influenced procedural failure rate (very low certainty evidence) and insufficient evidence to suggest that artificial intelligence‐supported handheld devices were superior to conventional ultrasound devices. Conclusions In patients with obesity, there is evidence of very‐low to moderate certainty that PPU improves markers of insertion success, with no indication of increased adverse effects. PPU should be used to reduce attempts. Further studies adhering to standardized outcome definitions are required for definitive recommendations. Registration The study protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022368271).https://doi.org/10.1002/hsr2.70039body mass indexneuraxialobesitypreproceduralpalpationspinal |
| spellingShingle | Aaron K. Khoo Annie Huynh Anita Pelecanos Victoria A. Eley Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review Health Science Reports body mass index neuraxial obesity preprocedural palpation spinal |
| title | Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review |
| title_full | Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review |
| title_fullStr | Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review |
| title_full_unstemmed | Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review |
| title_short | Does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first‐pass success in adults with obesity? A systematic review |
| title_sort | does preprocedural ultrasound prior to lumbar neuraxial anesthesia or analgesia increase first pass success in adults with obesity a systematic review |
| topic | body mass index neuraxial obesity preprocedural palpation spinal |
| url | https://doi.org/10.1002/hsr2.70039 |
| work_keys_str_mv | AT aaronkkhoo doespreproceduralultrasoundpriortolumbarneuraxialanesthesiaoranalgesiaincreasefirstpasssuccessinadultswithobesityasystematicreview AT anniehuynh doespreproceduralultrasoundpriortolumbarneuraxialanesthesiaoranalgesiaincreasefirstpasssuccessinadultswithobesityasystematicreview AT anitapelecanos doespreproceduralultrasoundpriortolumbarneuraxialanesthesiaoranalgesiaincreasefirstpasssuccessinadultswithobesityasystematicreview AT victoriaaeley doespreproceduralultrasoundpriortolumbarneuraxialanesthesiaoranalgesiaincreasefirstpasssuccessinadultswithobesityasystematicreview |