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Automated ultrasound guidance streamlines epidural placement for challenging patients in labor


Accuro’s image-guidance platform automates measurements of the spinal midline and epidural depth and trajectory in real time. Additionally, the device uses a new bone-specific image reconstruction technology called BoneEnhance. According to a study published recently in Investigative Radiology, Accuro was shown to deliver a five- to 10-fold increase in bone-to-tissue contrast compared to traditional ultrasound.

By contrast to unwieldy, complex, traditional ultrasound technology, Accuro is pocket-sized, portable and battery-powered. It can be carried right to the bedside, making it easy and practical to use in Labor and Delivery, and in a crowded operating room.
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At University of Kentucky College of Medicine, we have been using Accuro in Labor and Delivery for about a year. The hospital serves a significant population of obese patients on a busy Labor and Delivery floor. Given that, epidural administration may be uncomfortable and potentially problematic for these patients and a bottleneck for anesthesiologists. In many cases, anesthesiologists are simply unable to palpate a woman’s spine to identify the anatomical landmarks necessary to efficiently perform epidural analgesia.

Without palpation, anesthesiologists have no anatomical information as the basis for epidural placement – and experience, experimentation and guesswork come into play. As a result, the process can sometimes take as long as 30 to 40 minutes, compared to five to 10 minutes for typical patients. During that time, pregnant women sit hunched over and may have to endure several needle sticks until insertion is successful. If the needle hits bone, the result is more pain.

Accuro’s automated ultrasound guidance helps eliminate many of the problems of epidural placement for these difficult patients, as illustrated by two cases that I recently observed. In one, a resident and junior anesthesiology attending were attempting to administer an epidural to a C-section patient with a body mass index (BMI) of almost 50, who weighed about 270 pounds. Unable to feel the required spinal landmarks, they struggled for a long time to place the needle blindly. Then the resident suggested using the Accuro. Together they were able to successfully perform epidural anesthesia on the first attempt with the Accuro. This was the first time the attending had used the device and only the second time for the resident.

A second case involved a laboring woman with a BMI of 60 who also presented difficulties with spinal palpation. After numerous attempts at blind needle placement, the Accuro was employed to identify the spinal midline and interlaminar space at the correct vertebral level. The epidural catheter was then placed in just a few minutes.
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