First Look: Rivanna Medical Accuro Epidural and Spinal Anesthesia Guidance Device

The Rivanna Medical Accuro is a pocket-size, battery-operated ultrasound-based device that is used to provide automated guidance for spinal and epidural anesthesia needle placements. The device uses proprietary software to automatically identify spinal anatomy, including the depth to the epidural space, which enhances the performance of these procedures.

Typically, spinal and epidural anesthesia are performed by using anatomic landmarks and palpation to determine the appropriate location and to guide insertion of the anesthesia needle. Once the location is selected, the needle is advanced in a blind fashion, until the clinician determines that it has reached the desired target for the injection. The landmark method can be limited by such factors as clinician skill and patient characteristics such as obesity, limited back flexion, and spinal deformities (Chin et al. 2011).

The use of conventional 2-D ultrasound imaging has been found to enhance the success of spinal and epidural anesthesia procedures (Carvalho 2008, Chin et al. 2011, Perlas et al. 2016). The 2017 American Association of Nurse Anesthetists' (AANA)Analgesia and Anesthesia for the Obstetric Patient: Practice Guidelines state that ultrasound is a useful adjunct in patients with difficult-to-palpate anatomic landmarks, poor back flexion, and other conditions (AANA Board of Directors 2017). However, 2-D ultrasound is not commonly utilized because image acquisition is highly operator dependent, and interpreting the image can be challenging. The cost of an ultrasound scanner may also be a limiting factor.

The Accuro uses proprietary software to automate spinal landmark detection and depth measurements and to assess scan plane orientation in 3-D. Preliminary reports suggest that the Accuro allows accurate identification of spinal anatomy, compares favorably to the manual landmark and 2-D ultrasound methods when used to determine the depth to the epidural space, and is easier to learn and effectively use than conventional 2-D ultrasound (Tiouririne et al. 2017, Capogna et al. 2018, Seligman et al. 2018). However, additional studies are required to prove the overall clinical effectiveness of the Accuro, including its ability to reduce the incidence of complications and to shorten procedure time.

Note: ECRI Institute has not tested or rated the Accuro. This First Look is based on our hands-on assessment of the device, early literature reports, our review of product literature, and our surveys of device users.

*Figure 1.**The Accuro. (Image courtesy of Rivanna Medical.)*