INTRODUCTION: This review evaluates the efficacy and safety of Accuro, a handheld ultrasound device, compared to the palpation technique for neuraxial anaesthesia. Accuro provides real-time imaging guidance, potentially improving accuracy and efficiency. METHODS: A comprehensive search across six electronic databases identified randomised clinical trials comparing Accuro with palpation for neuraxial anaesthesia. Risk ratios or mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Bias risk was evaluated using the Cochrane Risk of Bias tool. RESULTS: Five studies (n=369) met the inclusion criteria. Accuro showed a favourable risk ratio for first insertion success (1.44 [95% CI [1.01, 2.05], p=0.05]). It significantly reduced needle skin passes (MD -0.63
95% CI [-1.05, -0.21]
p<
0.01), but not needle redirection (MD -1.31
95% CI [-2.71, 0.11]
p=0.07). Procedure time was shorter in palpation (MD 127.82
95% CI [8.68, -246.97]
p=0.04). Four studies had a low risk of bias
one had some concerns. CONCLUSION: Accuro can potentially improve success rates and reduce skin passes in neuraxial anaesthesia. Further trials with larger samples are needed, especially in patients with anticipated difficulties.