Lumbar ultrasound: useful gadget or time-consuming gimmick?

Despite widespread enthusiasm for using lumbar ultrasound in obstetrics, there are some who believe it is expensive and time-consuming, with undetermined risks and uncertain benefits. For decades, anesthesiologists have striven to perfect the identification and cannulation of the epidural space using skills learned during training and early clinical practice. These skills include knowledge of the relevant anatomy and detection of subtle tactile clues that aid successful placement of an epidural catheter. Indeed, obstetric anesthesiologists have managed to do this with great success without using imaging techniques. There is a long learning curve associated with lumbar ultrasound and it is unclear from the literature if the success rates associated with its use are superior to clinical skill alone. Is it only a matter of time before regulators insist that lumbar ultrasound is used before inserting an epidural? Indeed, this has already happened for central vein catheters. The United States spent $2.2 trillion on health care in 2007, nearly twice the average of other developed nations. If rapid health cost growth persists, one out of every four dollars in the US national economy will be tied up in the health system by 2025. Do obstetric anesthesiologists want to add to these costs by using unnecessary and expensive equipment? Although many feel that diagnostic ultrasound in obstetrics is safe, some argue that we have yet to perform an appropriate risk analysis for lumbar ultrasound during pregnancy. The issue of ultrasound bio-safety needs to be considered before we all jump on the ultrasound bandwagon.