Department of Anaesthesiology and Intensive Care, University Hospital of Muenster.
Ultraschall Med. 2012 Dec;33(7):E132-E137. doi: 10.1055/s-0029-1245724. Epub 2010 Nov 15.
The aim of this quantitative systematic review was to assess the efficacy and safety of ultrasound-guided neuraxial blocks in obstetric analgesia and anesthesia.
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).
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).
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.
本定量系统评价旨在评估超声引导下的脊神经阻滞在产科镇痛和麻醉中的疗效和安全性。
在 MEDLINE、EMBASE、CINAHL 和 CENTRAL 中进行了系统检索，以调查超声辅助脊神经阻滞与任何其他技术相比的疗效和安全性的临床试验。对于二项数据（例如，血管穿刺的患者数量），计算相对风险（RR），对于连续结果（例如，穿刺尝试的数量），计算平均值差异（MD），以及各自的 95%置信区间（95%CI）。
6 项临床试验（发表于 2001 年至 2009 年之间）包括 659 名患者的数据符合纳入标准。超声辅助脊神经阻滞需要更少的穿刺次数（MD：-0.92；95%CI：-1.11 至-0.74；p<0.00001）和更少的穿刺水平（MD：-0.2；95%CI：-0.31 至-0.1；p=0.0002）与传统的阻力损失相比。在据称困难的患者中，首次尝试超声引导下的成功率为 71%，而传统技术的成功率为 20%。接受超声辅助脊神经阻滞的患者，与程序相关的并发症（硬膜后穿刺头痛、脊髓或血管穿刺）发生率较低。
有一些证据表明，超声引导可能会提高产科脊神经阻滞的疗效和安全性。如果预计会出现技术困难，超声可能会降低与程序相关的不良事件发生率。
