The Efficacy of Neuraxial Ultrasound in the Obese Parturient

Introduction: Ultrasound technology may play a pivotal role in providing safe and effective neuraxial anesthesia for the obese parturient with difficult anatomical landmarks. Literature: There is a significant association between elevated BMI and epidural failure, suggesting higher BMI increases the risk of multiple needle attempts. The use of ultrasound may decrease the number of needle passes in the obese parturient. Purpose: The purpose of this project was to assess the efficacy of an ultrasound-assisted technique in minimizing needle passes, procedural complications, and procedural time for the obese parturient receiving neuraxial anesthesia. Methods: A retrospective chart review was performed on eligible parturients who received neuraxial anesthesia at ProMedica Toledo Hospital between October and December of 2021. In addition, a prospective quasi-experimental design was implemented to assess the efficacy of pre-assessment neuraxial ultrasound. Eligible participants with a BMI 30 kg/m² or greater received ultrasound-assisted site identification prior to spinal or epidural administration. Results: Ultrasound use yielded no statistically significant difference in the number of attempts for epidural (p=0.521), spinal anesthesia (p=0.931), or procedural complications (p=0.358). There was a statistically significant decrease in procedural time for ultrasound-assisted epidural placement (p=0.034), but no difference in subarachnoid blocks (p= 0.892). Conclusion: Implementation of an ultrasound-assisted technique for obese parturients receiving epidural anesthesia reduced procedural time. Ultrasound-assisted technique resulted in zero paresthesias and post-dural puncture headaches.