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October 14, 2018
10/14/2018 7:30:00 AM - 10/14/2018 9:30:00 AM
Room North, Hall D, Area C
Effectiveness of Accuro (A Handheld Ultrasound Device for Epidural Anesthesia)
Motonobu kimizuka, M.D., Yasuyuki Tokinaga, M.D.,Ph.D., Mayu Taguchi, M.D., Kanako Takahashi, M.D., Michiaki Yamakage, M.D.,Ph.D.
Sapporo Medical University School of Medicine, Sapporo, Japan
Disclosures: M. kimizuka: None. Y. Tokinaga: None. M. Taguchi: None. K. Takahashi: None. M. Yamakage: None.
Background It is often difficult to puncture the epidural in patients with spinal deformation and in obese patients. ACCURO (Rivanna Medical, VA) is a pocket-sized and battery-operated ultrasound instrument. It provides a spine imaging preset to facilitate epidural anesthesia with real-time 3D navigation of the lumbar spine and facilitates measurement of the depth to the epidural space. We assessed the effectiveness of the handheld ultrasound device for epidural anesthesia.

Methods With institutional research committee approval, the study was performed during the period from August 2016 to March 2018. Patients who were scheduled to undergo epidural anesthesia at L2/3-Th10/11 were randomly divided into an ACCURO group and a landmark group. The insertion point and depth to the epidural space were identified, marked, and measured using ACCURO. The time required at epidural placement from puncture start, the number of Touhy needle passes, actual depth to the epidural space and complications were recorded. We compared the accuracy of ACCURO measurements with the actual depth. Continuous data were analyzed using the Mann-Whitney U test,Bland-Altman plot. P value less than 0.05 was considered statistically significant. Results Sixty patients were recruited for the study. Fourteen senior residents performed epidural anesthesia. Demographic data (age, weight and height) were comparable in the two groups. There was no significant difference between the two groups in the time required for the placement. The average number of Touhy needle passes prior to successful placement was less in the ACCURO group than in the landmark group (1.73 vs 2.73,p=0.01). There was no complication in either group. The mean difference between depth to the epidural space measured by ACCURO and needle depth was -0.85 cm (95% confidence interval, -2.07 to 0.37)(Figure).ConclusionsThe results of this study showed that the use of ACCURO significantly reduced the number of passes required for epidural anesthesia. The shorter value of depth measured with ACCURO than the actual depth in all cases may lead to reduction in the incidence of epidural puncture.
Figure 1

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