A novel approach to neuraxial anesthesia: application of an automated ultrasound spinal landmark identification

Ting Ting Oh, Mohammad Ikhsan, Kok Kiong Tan, Sultana Rehena, Nian-Lin Reena Han, Alex Tiong Heng Sia, Ban Leong Sng, Ting Ting Oh, Mohammad Ikhsan, Kok Kiong Tan, Sultana Rehena, Nian-Lin Reena Han, Alex Tiong Heng Sia, Ban Leong Sng

Abstract

Background: Neuraxial procedures are commonly performed for therapeutic and diagnostic indications. Currently, they are typically performed via palpation-guided surface landmark. We devised a novel intelligent image processing system that identifies spinal landmarks using ultrasound images. Our primary aim was to evaluate the first attempt success rate of spinal anesthesia using landmarks obtained from the automated spinal landmark identification technique.

Methods: In this prospective cohort study, we recruited 100 patients who required spinal anesthesia for surgical procedures. The video from ultrasound scan image of the L3/4 interspinous space in the longitudinal view and the posterior complex in the transverse view were recorded. The demographic and clinical characteristics were collected and analyzed based on the success rates of the spinal insertion.

Results: Success rate (95%CI) for dural puncture at first attempt was 92.0% (85.0-95.9%). Median time to detection of posterior complex was 45.0 [IQR: 21.9, 77.3] secs. There is good correlation observed between the program-recorded depth and the clinician-measured depth to the posterior complex (r = 0.94).

Conclusions: The high success rate and short time taken to obtain the surface landmark with this novel automated ultrasound guided technique could be useful to clinicians to utilise ultrasound guided neuraxial techniques with confidence to identify the anatomical landmarks on the ultrasound scans. Future research would be to define the use in more complex patients during the administration of neuraxial blocks.

Trial registration: This study was retrospectively registered on clinicaltrials.gov registry ( NCT03535155 ) on 24 May 2018.

Keywords: Automated; Neuraxial anesthesia; Spinal Anaesthetics: anatomy; Ultrasound.

Conflict of interest statement

Ethics approval and consent to participate

This study received approval by the Singhealth Centralised Institutional Review Board (CIRB) (Ref: 2016/2262) on 22 April 2016. The written informed consent was obtained from every participant by the investigators.

Consent for publication

Not applicable.

Competing interests

Dr. Ban Leong SNG is an associate editor of BMC Anesthesiology. The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The step by step process of automated ultrasound spinal landmark identification.Please refer to the Methods, second paragraph
Fig. 2
Fig. 2
Midline View
Fig. 3
Fig. 3
Transverse view
Fig. 4
Fig. 4
Pearson’s correlation between program-recorded depth and the experienced clinician- measured depth to the posterior complex

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