The Comparative Accuracy of a Handheld and Console Ultrasound Device for Neuraxial Depth and Landmark Assessment

Abstract

(Int J Obstet Anesth. 2019;39:68–73) Historically, anesthesiologists have inserted neuraxial blocks for labor analgesia using surface landmarks as references to identify the interspaces and midline. There may be a number of advantages in using a neuraxial ultrasound device before the insertion procedure. Some benefits of ultrasound imaging include the ease of identifying the lumbar interspace level and ideal needle insertion site as well as the ability to estimate the depth to the epidural space. Previous studies have also reported that use of ultrasound resulted in fewer epidural failures, needle insertions, and needle redirections. While anesthesiologists have historically used laptop or console ultrasound machines to assist with neuraxial procedures, the portable handheld Accuro (AU; Rivanna Medical, Charlottesville, VA) device is a promising alternative for ultrasound imaging during lumbar epidural placements. It contains a proprietary algorithm that estimates the depth to the epidural space. The AU has not been compared with more complex ultrasound devices. This current study was conducted to compare the ultrasound-estimated depth to the epidural space as measured by the AU to depth measurements obtained with a console ultrasound (GU) device.