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Safety of ultrasound gel in real-time scanning of the lumbar spine in obstetric anaesthesia

Published:August 30, 2022DOI:https://doi.org/10.1016/j.ijoa.2022.103594
      We write to discuss the safety profile of ultrasound gel in the context of aiding obstetric neuraxial anaesthesia and analgesia. It is common practice when conducting lumbar ultrasound imaging before obstetric central neuraxial block to mark the puncture site by skin indentation with a blunt needle hub before then removing all traces of ultrasound gel prior to applying chlorhexidine skin antiseptic. This technique requires both the parturient and anaesthetist to hold and/or recall the exact body position and predicted needle trajectory for needle insertion. We have also found that the skin indentation may disappear during the preparation time thus reducing the benefits of pre-procedural scanning. This has led to suggestions that scanning be conducted after skin antisepsis with a sterile sheathed probe as this would shorten the interval between determining the optimal approach and needle insertion. However, we are concerned about risks of infection and neurotoxicity if ultrasound medium were to enter the subarachnoid or epidural space after the use of ultrasound gel in this way and have not found published guidance. We are aware of literature advocating the use of real-time ultrasound for spinal anaesthesia,
      • Karmakar M.K.
      • Li X.
      • Ho A.M.H.
      • Kwok W.H.
      • Chui P.T.
      Real-time ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique.
      • Liu Y.
      • Qian W.
      • Ke X.J.
      • Mei W.
      Real-time ultrasound-guided spinal anesthesia using a new paramedian transverse approach.
      • Conroy P.H.
      • Luyet C.
      • McCartney C.J.
      • McHardy P.G.
      Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach.
      but no reference is made relating to these concerns.
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