Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

All experts were familiar with, or had used this technology before.

Level of innovation

All experts said that the current procedure for spinal or epidural anaesthesia was to palpate the spinal landmarks to locate the intervertebral space. Two noted that conventional ultrasound could be used but that this is not very common because specialist skills are needed. Two experts said that this device was innovative because it makes it easy to find the intervertebral space by showing an image of the vertebrae superimposed on the ultrasound image. One also noted that minimal training was needed to use the device and that it was handheld and so could easily be used at the bedside. One expert said that the device can help with ultrasound-guided spinal or epidural block in maternity care because it is easier to use than the larger machines and when there are difficulties in giving a spinal block. Four experts thought that this device could be used in addition to standard care. One thought that it could replace current standard care over time.

Potential patient impact

Four experts said that this device could reduce procedure time and discomfort because of the need for fewer needle insertions. Four noted that this was particularly important in people with obesity or who have difficult spinal anatomy. One expert also said that a reduced needle insertion time could mean faster pain relief in labour and less delay in using spinal anaesthesia for urgent caesareans. Less delay in anaesthesia could also reduce time-related neonatal morbidity and the risk from having general anaesthesia. Three experts also noted that fewer needle insertion attempts could reduce the risk of post-dural-puncture headaches. All experts thought that this technology could particularly benefit people with obesity. However, 1 noted that ultrasound imaging for spinal anaesthesia can be difficult in people with obesity. They said that the success of the Accuro device depends on the effectiveness of the image processing capabilities. One expert suggested the device could be used for people with difficult spinal anatomy and anyone who has had previous failed or difficult attempts to give spinal or epidural anaesthesia. Three of the experts thought that the technology could ultimately be used for anyone needing regional anaesthesia.

Potential system impact

Two experts said it would cost more than current palpation techniques but would be cheaper than conventional ultrasound. Two thought that the device would cost the same as standard care, with 1 saying that this was because of a reduced need for extra kits and needles because of failed attempts. One expert thought that the procedure will cost more because of the capital equipment cost, disposable items, and increased length of time to do the procedure. Four experts said that only a short amount of training was needed to use this device.

General comments

Three experts highlighted that there are general risks associated with giving spinal or epidural anaesthesia, which include infection, dural tear, post-dural-puncture headache, spinal block failure and damage to nerve roots and the spinal cord. One expert highlighted that proper training in anaesthetic techniques is still needed. Two experts said that the user needs to be aware of the device's limitations, such as the depth estimation, to prevent potential adverse events. One said that the depth estimates can vary depending on the pressure applied to the tissue and the angle that the device is held, so the depth estimation should be used with caution.