ESRA19-0072 Ultrasound-assisted spinal anesthesia: efficacy of a handheld ultrasound device for epidural injections in chronic pain

Background and aims Epidural injections of corticosteroids are commonly used as a nonsurgical treatment for radicular pain. Preprocedure ultrasound neuraxial has been associated with reduced risk of location failure of the epidural space. A handheld ultrasound device (Accuro, Rivanna Medical) recognizes lumbar spine bony landmarks and offering automated real-time identification of interspaces and epidural depth. The aim of this study was to evaluate the accuracy of epidural depth estimation of an ultrasound device. Methods 14 patients with lumbar radiculopathy, but without significant degenerative changes or anatomical abnormalities, were included in our prospective study. After the sonographic location, the device allowed to place a mark where the puncture was performed and provided an estimated distance to the epidural space. A transforaminal approach was performed through loss of resistance technique. Later, a mixture of LA and nonparticulated steroids was injected. Results The mean age was 64.21 years (SD 6.39) and BMI was 29.36 (SD 3.52). The mean needle distance was 5.32 ± 0.69 cm (4.0–6.8 cm), the mean estimated depth for divide was 4.07 ± 0.53 cm (3.0–5.2 cm), with a mean difference of -1.25 cm (SD 0.67 cm). All the epidural spaces were located at the point marked; only 5/14 patients needed a minimum redirection of the needle. Time was less than 5 minutes in all patients and the mean was 171.29 sec (SD 43.94). There were no complications. Conclusions The use of handheld ultrasound Accuro underestimates the distance skin-epidural space but helps the location of space, quickly and with few movements of the needle.