Ultrasonographic Guidance in the Prediction of Difficult Spinal Anaesthesia in Older Patients

Spinal anesthesia can be difficult especially in geriatric patients, due to age-related changes in the lumbar spine. Traditionally, surface anatomical landmarks have been used as a guide for directing the spinal needle in to the subarachnoid space, but many a time, this may be difficult as the landmarks may be difficult to palpate. Hence we wanted to test the efficacy of pre-procedural ultra-sound imaging to locate the ideal space for placement of the spinal needle. Our study included one hundred patients at or above the age of 55yrs undergoing elective surgeries under spinal anesthesia. They were divided in to 2 groups of 50 each. One group was given spinal anesthesia based on clinical parameters, while the other group based on ultrasound parameters and findings. The statistical analysis was carried out using SPSS 16 software. We observed that the number of attempts and the need to change the space or needle was much lesser in the ultrasound group. Hence we concluded that a pre-procedural ultra-sound imaging predicts difficult spinal anesthesia in older patients and can be utilized to locate the ideal space for placement of the spinal needle.