Ultrasound Guidance Significantly Lowers Risk for Failed Lumbar Punctures and Epidural Catheterizations.

The failure rate was 1% with ultrasound and 7% with standard palpation of landmarks.

Lumbar puncture (LP) is performed for diagnostic purposes (e.g., analysis of cerebrospinal fluid [CSF]) and for drug delivery, and epidural catheterization is performed to administer anesthetics. But sometimes these procedures fail. In this meta-analysis of 17 randomized, controlled trials involving 1300 patients, investigators determined whether ultrasound (US)-guided imaging, compared with standard palpation of anatomical landmarks, can lower risk for failed LPs or epidural catheterizations.

Five studies evaluated LP and nine evaluated epidural catheterization. Failed LP was defined as lack of CSF return; failed epidural catheterization was defined as inability to place an epidural catheter, need for intraoperative analgesia, or need to replace the catheter. Overall, 1% of procedures failed in the US group, compared with 7% in the standard-technique group. US-guided imaging was associated with significantly lower risk for both failed LP and failed epidural catheterization (risk ratio, 0.20 for each). Likewise, US-guided imaging significantly reduced the number of traumatic procedures (defined as “visible blood aspiration or a red blood cell count” in the CSF), insertion attempts, and needle redirections.

Comment: Unsurprisingly, use of ultrasound-guided imaging during lumbar puncture and epidural catheterization decreased the chances of adverse outcomes. The authors conclude that US-guided imaging could “be a useful adjunct” for these procedures, particularly in settings where they are commonly performed (e.g., obstetrics) or “where failure is associated with particularly negative consequences” (e.g., pediatrics).


Source: Journal Watch General Medicine

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