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DOI: 10.1055/s-0029-1245724
© Georg Thieme Verlag KG Stuttgart · New York
Ultrasound Guidance for Neuraxial Analgesia and Anesthesia in Obstetrics: a Quantitative Systematic Review
Ultraschallgesteuerte neuroaxiale Blockaden in der Geburtshilfe: eine quantitative systematische ÜbersichtsarbeitPublication History
received: 12.11.2009
accepted: 6.8.2010
Publication Date:
15 November 2010 (online)
![](https://www.thieme-connect.de/media/ultraschall/201207/lookinside/thumbnails/10.1055-s-0029-1245724-1.jpg)
Zusammenfassung
Ziel: Ziel dieser quantitativen, systematischen Übersichtsarbeit war es, die Effektivität der Ultraschallanwendung bei der Anlage von Epidural- und Spinalanästhesien in der Geburtshilfe zu untersuchen. Material und Methoden: Die systematische Literatursuche in MEDLINE, EMBASE, CINAHL und CENTRAL identifizierte alle randomisierten kontrollierten Studien. Als Effektivitätsmaßzahlen wurden neben dem jeweiligen Konfidenzintervall (95 %-CI) für kontinuierliche Daten (z. B. durchschnittliche Anzahl an Punktionsversuchen) die Mittlere Differenz (MD) bzw. für dichotome Größen (z. B. Anzahl an Patienten mit „blutigen“ Punktionen) das Relative Risiko (RR) berechnet. Ergebnisse: 6 Studien (publiziert zwischen 2001 – 2009) mit den Daten von 659 schwangeren Patientinnen erfüllten die Einschlusskriterien. Der Einsatz des Ultraschalls wies im Vergleich zur körperlichen Untersuchung eine geringere Gesamtanzahl an Punktionsversuchen (MD: –0,92; 95 % CI: –1,11 bis –0,74; p < 0,00001) und punktierten Wirbelkörperhöhen (MD: –0,2; 95 % CI: –0,31 bis –0,1; p = 0,0002) auf. Die Inzidenz der erfolgreichen Punktionen im ersten Versuch betrug unter Ultraschallkontrolle 71 % im Vergleich zu 20 % in der Kontrollgruppe. Auch in Bezug auf die Reduktion der Komplikationsrate in der geburtshilflichen Anästhesie erwies sich die Ultraschallanwendung als effektives Hilfsmittel (z. B. Anzahl an blutigen Punktionen; RR: 0,28; 95 % CI: 0,14 – 0,57; p = 0,0005). Schlussfolgerung: Es gibt aktuell einige Daten, die darauf hinweisen, dass der Ultraschall eine hilfreiche Ergänzung im Rahmen der geburtshilflichen Anästhesie sein könnte. Der Einsatz des Ultraschalls kann insbesondere bei Frauen mit speziellen Risiken (Adipositas, Skoliose, Dorsale Instrumentierung) zur Anlage einer zentralen Leitungsblockade empfohlen werden.
Abstract
Purpose: The aim of this quantitative systematic review was to assess the efficacy and safety of ultrasound-guided neuraxial blocks in obstetric analgesia and anesthesia. Materials and Methods: A systematic search for clinical trials investigating the efficacy and safety of ultrasound-assisted neuraxial blocks in comparison to any other technique was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. Relative risks (RR) were calculated for dichotomous data (e. g. number of patients with vascular punctures), and mean differences (MD) were calculated for continuous outcomes (e. g. number puncture attempts), along with the respective 95 % confidence intervals (95 % CI). Results: Six clinical trials (published between 2001 and 2009) including the data of 659 patients satisfied the inclusion criteria. Ultrasound-facilitated neuraxial blocks required a lower number of puncture attempts (MD: –0.92; 95 % CI: –1.11 to –0.74; p < 0.00001) and fewer puncture levels (MD: –0.2; 95 % CI: –0.31 to –0.1; p = 0.0002) in comparison with the more conventional loss of resistance. The success rate with the first attempt under ultrasound guidance in supposedly difficult patients was 71 % in comparison to 20 % using a conventional technique. Patients receiving ultrasound-assisted neuraxial blocks had a lower rate of procedure-related complications (post-dural puncture headache, spinal or vascular puncture). Conclusion: There is some evidence that ultrasound guidance may improve the efficacy and safety of neuraxial blocks in obstetrics. If technical difficulties are anticipated, ultrasound may lower the rate of procedure-related adverse events.
Key words
systematic review - epidural analgesia - ultrasound
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Dr. Alexander Schnabel
Department of Anaesthesiology and Intensive Care, University Hospital of Muenster
Albert Schweizer Str. 33
48153 Münster
Germany
Phone: ++ 49/2 51/8 34 72 53
Fax: ++ 49/2 51/8 34 72 53
Email: alexander_schnabel@gmx.de