In medicine, small errors can have profound implications. And in epidural and spinal anesthesia, sacrifices in precision correlate to sacrifices in patient care. It’s that simple. These procedures — absolutely crucial for pain management through childbirth and otherwise agonizing surgeries — have historically placed high pressure on the steady hands of anesthesiologists. The stakes are a heavy burden for even the most experienced clinicians, and every tool to improve odds is a boon for providers and patients alike.
Yes. We’re talking about ultrasound guidance for epidurals and spinal anesthesia. We’re talking about technology that provides real-time visualization of spinal anatomy, guiding anesthesiologists through complex workflows and delicate anatomical terrain, where margins for error are notably slim. We’re talking about devices made accessible to providers across the globe at a time when resources are low and risks are high. And we’re just getting started.
Potential risks of epidural and spinal anesthesia
In use cases across childbirth, surgery, and pain management, neuraxial anesthesia is a well-established and highly relied-on intervention. Epidural and spinal anesthesia offer significant pain relief, but they’re not without risks associated with needle placement. Efficacy is directly tied to administration, and there are a host of potential risks inherent to every case.
- Dural puncture: Puncture of the dura mater, the outermost layer of the spinal cord
- Injection into a false lumen: Unintentional administration of medication into an epidural blood vessel or adipose tissue
- Inadvertent subarachnoid blocks: Inadvertent injection into the subarachnoid space leading to a more extensive block than intended
- Intrathecal injection: Unintended injection of medication directly into the cerebrospinal fluid
- Inadequate analgesia: Failure to achieve adequate pain relief
- Repeat injections: Multiple attempts required to correctly place the epidural catheter
Anesthesiologists and patients bear the full burden of these risks, despite factors beyond their control. A steady hand and experienced needle placement can be quickly negated by a patient’s complex anatomy. And when errors occur, patients suffer discomfort following procedures, nerve sensitivity, persistent headaches, and occasionally lasting and life-threatening complications. Regardless of how experienced or careful an anesthesiologist is, blind palpation limits their options for taking control of outcomes when placing an epidural for patients with complex anatomies.
We’re changing that.
Anesthesiologists mitigate risks with ultrasound guidance
Accuro Neuraxial Ultrasound Guidance is a valuable tool for anesthesiologists striving to improve standards of care. It illuminates the unknowns of needle placement, improving the safety and efficacy of epidural and spinal anesthesia. Unlike traditional techniques that rely on feeling anatomical landmarks, ultrasound guidance allows anesthesiologists to visualize spinal anatomy in real time. Accuro, for instance, allows for precise identification of critical structures like the interlaminar space with high bone-to-tissue contrast. This enhanced visualization reduces the risk of needle misplacement and associated complications. Accuro also goes beyond simple visualization by providing a graphical overlay directly on the ultrasound image. This overlay accurately pinpoints the optimal location for needle insertion, ensuring the epidural or spinal space is targeted for the best possible outcomes.
Enhanced visualization for planning needle placements — and for assessing the viability of epidural placements in patients with complex anatomy — reduces complications upfront. But it also improves clinical confidence administering neuraxial blocks for patients who might otherwise be denied epidurals due to higher risks.
Clinical evidence behind ultrasound guidance
A growing body of global research supports both the variability of factors affecting epidural placement and the use of ultrasound to guide the placement of neuraxial blocks. Overwhelmingly, tools like Accuro are being recognized as significant advancements in pursuit of optimal outcomes. By providing anatomical visualizations of the target area and offering real-time feedback, Accuro helps anesthesiologists achieve successful placement of the epidural or spinal catheter on the first try (81%).
The precise depth estimates and needle targeting facilitated by ultrasound guidance also significantly reduce the potential for dural punctures, false lumen injections, and other complications. This translates to a safer and more effective experience for patients undergoing epidural or spinal anesthesia.
These results are only the beginning. Ultrasound is already benefitting significantly from artificial intelligence (AI) and machine learning (ML). These technologies are breaking new ground daily — for better anatomical imaging, assistive needle placement, anomaly recognition, and far more. Each new innovation empowers anesthesiologists to better visualize patient anatomies and guide the best possible needle placement.
Empowering clinicians — improving care
Epidurals and spinal anesthesia remain essential tools for pain management, but minimizing risks during placement is becoming more of a priority — as well it should. Ultrasound guidance is driving up standards on two concerted fronts. First, it makes epidural procedures easier and safer. And second, it reduces the acceptability of complications.
As we move forward into the future of tech-enhanced anesthesiology and medicine, we’ll continue to see ultrasound guidance changing procedures — and, most importantly, changing lives.