The Evidence

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Clinical Evidence

Performance Inspired. Automatically identify epidural location “with one hand tied behind your back.”

Because Accuro is better than 94%* successful in automatically identifying epidural location, Accuro replaces the guesswork that comes with “blind-needle guidance” with confidence when you’re performing epidurals or spinals.

CLINICALLY PROVEN BENEFITS

Identifies a given lumbar intervertebral space
Furness G, et al. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anesthesia. 57:277-280, 2002.
Halpern S, et al. The use of ultrasound for lumbar spinous process identification: a pilot study. Can J Anaesth. 57:817-22, 2010.
Lee A, et al. Ultrasound assessment of the vertebral level of the intercristal line in pregnancy. Anesth Analg. 113:559-564, 2011.
Locks G, et al. Use of the ultrasound to determine the level of lumbar puncture in pregnant women. Rev Bras Anestesiol. 60:13-10, 2010.
Schlotterbeck H, et al. Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anesthesia. Br J Anesth. 100:230-234, 2008.
Watson M, et al. Could ultrasonography be used by an anaesthetist to identify a specified lumbar interspace before spinal anaesthesia? Br J Anaesth. 90:509-511, 2003.
Whitty R, et al. Identification of the lumbar interspinous spaces: palpation versus ultrasound. Anesth Analg. 106:538-540, 2008.
Duniec L, et al. Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30%. Anaesthesiol Intensive Ther. 45: 1-6, 2013.
Predicts needle insertion depth required to reach the epidural space
Arzola, C, et al. Ultarsound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg. 104:1188-1192, 2007.
Balki M, et al. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 108: 1876-1881, 2009.
Chin K, et al. An ultrasound-assisted approach facilitates spinal anesthesia for total joint arthroplasty. Can J Anesth. 56:643-650, 2009.
Cork R, et al. Ultrasonic localization of the lumbar epidural space. Anesthesiology. 52: 513-516, 1980.
Currie J. Measurement of the depth to the extradural space using ultrasound. Br J Anaesth. 56:345-347, 1984.
Ferre R and Weeney T. Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med. 25:291-296, 2007.
Gnaho A, et al. Assessing the depth of the subarachnoid space by ultrasound. Rev Bras Anestesiol. 2:520-530, 2012.
Grau T, et al. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 45:766-771, 2001.
Grau T, et al. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med. 26:64-67, 2001.
Grau T, et al. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 14:169-175, 2002.
Helayel P, et al. Evaluating the depth of the epidural space with the use of ultrasound. 60:376-382, 2010.
Tran D, et al. Preinsertion paramedian ultrasound guidance for epidural anesthesia. Anesth Analg. 109:661-667, 2009.
Vallejo M, et al. Ultrasound decreases the failed labor epidural rate in resident trainees. Int J Obstet Anesth. 19:373-378, 2010.
Improves success of spinal anesthesia, reduces number of needle sticks, improves safety
Grau T, et al. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 45:766-771, 2001.
Grau T, et al. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med. 26:64-67, 2001.
Grau T, et al. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 14:169-175, 2002.
Vallejo M, et al. Ultrasound decreases the failed labor epidural rate in resident trainees. Int J Obstet Anesth. 19:373-378, 2010.
Chin K, et al. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 115:94-101, 2011.
Grau T, et al. Real-time ultrasonic observation of combined spinal-epidural anaesthesia. Eur J Anaesthesiol. 21:25-31, 2004.
Nomura J, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med. 26:1341-1348, 2007.
Wang Q, et al. Ultrasound facilitates identification of combined spinal-epidural puncture in obese parturients. Chin Med J (Engl). 125:3840-3843, 2012.
Ansari T, et al. Ultrasound-guided spinal anesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth. 23:213-216, 2014.
Lim Y, et al. A randomized controlled trial of ultrasound-assisted spinal anesthesia. Anaesth Intensive Care. 42:191-198, 2014.
Mofidi M, et al. Ultrasound guided lumbar puncture in emergency department: time saving and less complications. J Res Med Sci. 18:303-307, 2013.
Sahin T, et al. A randomized controlled trial of preinsertion ultrasound guidance for spinal anesthesia in pregnancy: outcomes among obese and lean parturients: ultrasound for spinal anesthesia in pregnancy. J Anesth. 28:413-419, 2014.
Perlas A, et al. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg Anesth and Pain Med. 40, 2015.

Note: Estimated 79% reduction in risk of failed lumbar puncture or epidural catheterization from multiple studies (estimated by Perlas et al 2015)
Note: Estimated 73% reduction in risk of traumatic procedure from multiple studies (estimated by Perlas et al 2015)
Provides same efficacy as fluoroscopy in guiding lumbar epidural anesthesia
Evansa I, et al. Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases: A randomized study. Eur J Anaesthesiol 32: 262-268, 2015.
Automates epidural space identification and midline with high accuracy
M. Tiouririne, A.J. Dixon, K. Owen, F. W. Mauldin, Jr. Dedicated handheld ultrasound system for spinal and epidural placement. American Society of Anesthesiologists. San Diego, CA, October 27, 2015.
*M. Tiouririne, et al., “Imaging performance of a handheld ultrasound system with real-time computer-aided detection of lumbar spine anatomy: a feasibility study.” Investigative Radiology. 2017; 52(8): 1-8. Study was performed in the lumbar spine region for both obese and normal BMI subjects.