Ultrasound for Central Neuraxial Blockade

Abstract

The evidence base supporting the role of ultrasound to assist the performance of neuraxial anesthesia has become increasingly strong over the last decade. In both the lumbar and thoracic spine, ultrasound has been shown to optimize technical performance, improve patient outcomes, and potentially reduce harm. Specifically, ultrasound aids in identification of intervertebral levels, estimation of depth to epidural and intrathecal spaces, and localization of important landmarks including the midline and interlaminar space. These characteristics can facilitate both planning and performance of neuraxial blockade by reducing the required number of needle insertions and redirections, minimizing the risk of traumatic needle placements, and improving block effectiveness after epidural placement. This report details the evidence supporting each of these outcomes and also discusses the current understanding of both learning and teaching the skill of neuraxial ultrasonography.