Computer-Aided Ultrasound for Neuraxial Anesthesia

Computer-aided ultrasound uses artificial intelligence algorithms to assist clinicians in identifying anatomical landmarks and guiding needle placement during procedures. In neuraxial anesthesia, these systems aim to automatically detect structures such as intervertebral spaces and suggest optimal insertion points based on ultrasound imaging. By improving image interpretation and procedural guidance, computer-aided ultrasound may increase accuracy, efficiency, and first-pass success rates in neuraxial anesthesia while reducing complications.  

A 2021 randomized control trial (RCT) evaluated the effectiveness of the AI-assisted Accuro handheld ultrasound device versus traditional palpation guidance for combined spinal-epidural anesthesia in 80 obese parturients undergoing cesarean delivery. The ultrasound group demonstrated significantly higher first-insertion success rates, fewer needle redirections, lower rates of paresthesia, and faster identification of the puncture site compared to the palpation group. However, overall procedure times and other complications did not differ significantly between groups. These findings suggest that AI-assisted ultrasound guidance may improve the accuracy, efficiency, and safety of neuraxial anesthesia in obese obstetric patients, though it may not have a large impact on overall surgical efficiency.¹   

Another RCT compared computer-aided handheld ultrasound guidance with conventional landmark palpation for combined spinal-epidural analgesia in 84 laboring women. Although total procedure time did not significantly differ between groups, the ultrasound group demonstrated shorter performance times and higher first-attempt epidural success rates. The ultrasound-guided technique also reduced the number of insertion attempts and showed a trend toward fewer accidental dural punctures, while ultrasound depth measurements closely correlated with actual needle depth.²  

A meta-analysis including 74 studies and 7,090 patients compared computer-aided ultrasound, preprocedural ultrasound, real-time ultrasound, and landmark-guided techniques for neuraxial anesthesia. Compared with landmark guidance, computer-aided, preprocedural, and real-time ultrasound significantly improved first-pass and first-attempt success rates. Computer-aided ultrasound also showed potential benefits in procedural success. Ultrasound-guided techniques generally demonstrated similar procedure times to landmark methods, with some evidence of improved patient satisfaction and lower rates of adverse events such as paresthesia and unintentional dural puncture.³  

On the other hand, a 2024 systematic review evaluated 7 RCTs involving 594 patients to compare computer-aided ultrasound guidance with traditional anatomical landmark techniques.  Overall, computer-aided ultrasound guidance did not significantly improve first-pass success compared with landmark guidance (RR = 1.39, with a 95% confidence interval [CI] 0.89–2.16) and showed no significant reduction in total procedure time (MD = 0.85 minutes, with a 95% CI −0.81 to 2.51). This review was limited by the small number of included trials, heterogeneous study designs and patient populations, and somewhat low-certainty evidence with risk of bias.⁴  

The available evidence on computer-aided ultrasound for neuraxial anesthesia is promising but mixed, with some studies suggesting improvements in accuracy, first-attempt success, and procedural efficiency, while other data shows no clear advantage in first-pass success or overall procedure time. Larger, better-designed RCTs would be beneficial in clarifying clinical benefit and establishing the role of computer-aided ultrasound in routine neuraxial anesthesia practice, which remains a compelling area for future research. 

References 

1. Ni X, Li MZ, Zhou SQ, et al. Accuro Ultrasound-based System with Computer-aided Image Interpretation Compared to Traditional Palpation Technique for Neuraxial Anesthesia Placement in Obese Parturients Undergoing Cesarean Delivery: A Randomized Controlled Trial. Journal of Anesthesia. 2021;35(4):475-482. https://doi.org/10.1007/s00540-021-02922-y  

2. Bae J, Kim Y, Yoo S, et al. Handheld Ultrasound-Assisted Versus Palpation-Guided Combined Spinal-Epidural for Labor Analgesia: A Randomized Controlled Trial. Sci Rep. 2023, 13:23009. https://doi.org/10.1038/s41598023-50407-7  

3. Kamimura Y, Yamamoto N, Akihiro Shiroshita, et al. Comparative efficacy of ultrasound guidance or conventional anatomical landmarks for neuraxial puncture in adult patients: a systematic review and network meta-analysis. British Journal of Anaesthesia. Published online October 1, 2023. https://doi.org/10.1016/j.bja.2023.09.006  

4. Kamimura Y, Ito H, Tsuji T, Nakanishi T, Kazuya Sobue. Efficacy of Computer-Aided Three-Dimensional Ultrasound Guidance for Neuraxial Anesthesia in Adult Patients: A Systematic Review and Meta-Analysis. Cureus. Published online October 29, 2024. https://doi.org/10.7759/cureus.72657