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Automated ultrasound guidance streamlines epidural placement for challenging patients in labor

By Dr. Regina Fragneto

It’s no secret that childbirth hurts. For most women, it is characterized by intense pain and pressure in the lower abdomen and back – and for some, this can be overwhelming. Many patients choose relief through epidural analgesia, which involves injection of a local anesthetic near nerve roots in the lumbar spinal region. This inhibits nerve conduction, decreasing sensation in the lower half of the body.

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But pain relief itself can hurt. Physicians must caution patients that epidural analgesia can lead to complications and some pain may be associated with the epidural procedure itself, adding to anxiety during an already anxious time. These complications can include spinal headache, which can be severe, and soreness at the site of the epidural. While the risk is minimal for the average patient, in certain populations – among them women with high body mass index (BMI) and scoliosis or other spinal deformities – it may be greater due to technical difficulties associated with the epidural delivery. In addition, problematic anesthesia delivery is painful to the medical system due to increased costs of prolonged procedures and patient discomfort and dissatisfaction.

Even in today’s advanced healthcare age, epidural delivery can be difficult because many anesthesiologists continue to perform the procedure as if they had virtual blinders on. When attempting to pinpoint the optimal site for injection of a powerful drug, they still rely on their sense of touch to assess spinal anatomy. In obese patients and those with spinal anomalies, needle placement is challenging because physicians cannot successfully palpate the spine to determine the appropriate injection site.

Image guidance for epidural placement would remove the physician’s virtual blindfold to improve accuracy. However, many imaging modalities involve X-ray exposure, which should be avoided in a woman carrying a fetus.

Ultrasound, however, involves no radiation, and research has shown the technology helpful in accurately identifying the appropriate epidural injection site. But performing and interpreting ultrasound requires specialized training and experience that is not in some anesthesiologists’ skill set.

Modern technological advances have led to the development of a range of specialized ultrasound devices, including the novel Accuro device by Rivanna Medical (Charlottesville, Virginia). The device applies automated 3D-navigation to spinal ultrasound imaging, eliminating the steep learning curve of interpreting and using ultrasound images to support epidural anesthesia administration. Accuro provides anesthesiologists, regardless of their ultrasound experience, with a clear route to the appropriate epidural site.
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