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Purpose of Review This article describes the anatomy of the spine, relevant ultrasonographic views, and the techniques used to perform the neuraxial blocks using ultrasound imaging. Finally, we review the available evidence for the use of ultrasound imaging to perform neuraxial blocks. Recent Findings Central neuraxial blockade using traditional landmark palpation is a reliable technique to provide surgical anesthesia and postoperative analgesia. However, factors like obesity, spinal deformity, and previous spine surgery can make the procedure challenging. The use of ultrasound imaging has been shown to assist in these scenarios. Summary Preprocedural imaging minimizes the technical difficulty of spinal and epidural placement with fewer needle passes and skin punctures. It helps to accurately identify the midline, vertebral level, interlaminar space, and can predict the depth to the epidural and intrathecal spaces. By providing information about the best angle and direction of approach, in addition to the depth, ultrasound imaging allows planning an ideal trajectory for a successful block. These benefits are most noticeable when expert operators carry out the ultrasound examination and for patients with predicted difficult spinal anatomy. Recent evidence suggests that pre-procedural neuraxial ultrasound imaging may reduce complications such as vascular puncture, headache, and backache. Neuraxial ultrasound imaging should be in the skill set of every anesthesiologist who routinely performs lumbar or thoracic neuraxial blockade. We recommend using preprocedural neuraxial imaging routinely to acquire and maintain the imaging skills to enable success for challenging neuraxial procedures.

Ultrasound Imaging of the Spine for Central Neuraxial Blockade: a Technical Description and Evidence Update