Efficacy and safety of ultrasound-guided versus landmark-guided neuraxial puncture: a systematic review, network meta-analysis and trial sequential analysis of randomized clinical trials
Authors' conclusion
Ultrasound-guided neuraxial puncture improves efficacy, reduces puncture attempts and needle redirections, reduces complication risks, and increases patient satisfaction, with low to moderate certainty of evidence.
Study context
- Population
- Adults undergoing neuraxial puncture
- Participants
- 7,153 adults · 71 studies
- Comparison
- Real-time ultrasound vs Preprocedural ultrasound vs Landmark palpation
- Outcome
- Failed first-attempt neuraxial puncture
Methodological detailstrial sequential analysis, GRADE certainty assessment
- Trial sequential analysis
- GRADE certainty assessment
Pooled result
As reported in the abstract
Each group vs landmark palpationOdds ratio (95% CrI)
Real-time ultrasoundCrI; low certainty
0.30(0.15–0.58)
Preprocedural ultrasoundCrI; moderate certainty
0.33(0.24–0.44)
Further pooled results
| Outcome | OR (95% CrI) | |
|---|---|---|
| Complete neuraxial puncture failurePreprocedural ultrasound vs Landmark palpation · CrI | 0.29 (0.11–0.61) | |
| 0.10.31310Odds ratio (log scale) |
- Complete neuraxial puncture failure: 95% CrI
Complete neuraxial puncture failure
- Real-time ultrasound leading method but no statistically significant difference vs landmark palpation
Patient satisfaction
- Increased with ultrasound-guided approaches
Safety
- Reduction in certain complications with ultrasound-guided approaches; no other significant differences in additional outcomes
Original publication
Efficacy and safety of ultrasound-guided versus landmark-guided neuraxial puncture: a systematic review, network meta-analysis and trial sequential analysis of randomized clinical trials. Reg Anesth Pain Med. Published 14 June 2024. doi:10.
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