Key result
Ultrasound showing only the posterior or neither dura mater complex predicted difficult spinal anesthesia with positive predictive values of 76% and 100%, vs 6% when both were visible (P<0.001).
Why the study?
The study aimed to verify the efficacy of ultrasonography in predicting difficult spinal anesthesia through the analysis of different ultrasound patterns.
Does ultrasound evaluation of dura mater complexes predict difficult spinal anesthesia in patients undergoing orthopedic or urological surgery?
Observational (n=100)
Single-blind
Does ultrasound evaluation of dura mater complexes predict difficult spinal anesthesia in patients undergoing orthopedic or urological surgery?
p-value: p=<0.001
Ultrasound evaluation of dura mater complexes accurately predicts difficult spinal anesthesia, suggesting its utility in routine clinical practice to improve success rates.
Ultrasound patterns of dura mater complexes may identify difficult spinal anesthesia cases; leaves open whether routine preprocedural scanning improves outcomes.
BACKGROUND: Ultrasound showed to improve the precision and efficacy of spinal anesthesia (SA) through the identification of specific structures surrounding the intrathecal space, such as the anterior and posterior complex of dura mater (DM). The aim of this study was to verify the efficacy of ultrasonography in predicting difficult SA trough the analysis of different ultrasound patterns. METHODS: This prospective single-blind observational study involved 100 patients undergoing orthopedic or urological surgery. A first operator chose by landmarks the intervertebral space where he wanted to perform SA. Then a second operator recorded the visibility of DM complexes at ultrasound. Subsequently, the first operator, blinded to the ultrasound evaluation, performed SA, defined as "difficult" in case of failure, change of intervertebral space, operator exchange, duration >400 seconds or more than 10 needle passes. RESULTS: The ultrasound visualization of only posterior complex or the failure in visualization of both complexes showed a positive predictive value of 76% and 100%, respectively, towards difficult SA vs. 6% when both complexes were visible; P<0.001. A negative correlation was found between the number of visible complexes and both patients' age and BMI. Landmark-guided evaluation underestimated the intervertebral level in 30% of cases. CONCLUSIONS: Ultrasound showed a high accuracy in detecting difficult spinal anesthesia and its use should be recommended in the daily clinical practice in order to increase success rate and minimize patient discomfort. The absence of both DM complexes at ultrasound should lead the anesthetist to evaluate other intervertebral levels or consider alternative techniques.
No takes yet. Share an insight, caveat, or question.
Pascarella et al. (2023) conducted an observational in Orthopedic or urological surgery requiring spinal anesthesia (n=100). Ultrasound visualization of dura mater complexes vs. Visibility of both dura mater complexes was evaluated on Difficult spinal anesthesia (failure, change of intervertebral space, operator exchange, duration >400 seconds or >10 needle passes) (p=<0.001). Ultrasound showing only the posterior or neither dura mater complex predicted difficult spinal anesthesia with positive predictive values of 76% and 100%, vs 6% when both were visible (P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: