Key result
Preprocedural ultrasonography significantly increased the rate of successful access to the subarachnoid space on the first attempt compared to landmark-guided palpation (74.4% vs 53.8%) in elderly patients with difficult anatomy.
Why the study?
To determine whether preprocedural ultrasonography affects the technical performance of spinal anesthesia in elderly patients with difficult anatomy.
Does preprocedural ultrasonography improve the rate of successful access to the subarachnoid space on initial needle insertion attempt in elderly patients with difficult anatomy?
RCT (n=156)
Single-blind
Closed envelope method
No
Does preprocedural ultrasonography improve the rate of successful access to the subarachnoid space on initial needle insertion attempt in elderly patients with difficult anatomy?
Absolute Event Rate: 74.4% vs 53.8%
p-value: p=0.008
Preprocedural ultrasonography significantly improves the first-attempt success rate of spinal anesthesia in elderly patients with difficult anatomy compared to the conventional landmark technique.
Supports routine preprocedural ultrasonography for spinal access in elderly patients with difficult anatomy; confirms RCT benefit over landmarks.
OBJECTIVE: This study was aimed to determine whether preprocedural ultrasonography (USG) affects the technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis, or previous spine surgery. MATERIALS AND METHODS: This prospective study was conducted in 156 elderly patients scheduled for elective orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique (group P). The primary finding of our study was the rate of successful access to the subarachnoid space on initial needle insertion attempt. Secondary achievements included number of needle insertion attempts, number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia. RESULTS: The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P, 3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among the patients in group P than those in group U. No statistically significant difference was found between the groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced complications (p>0.05). CONCLUSION: Our study findings showed that preprocedural neuroaxial USG improves technical performance of spinal anesthesia in elderly patients with difficult anatomy.
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Uyel et al. (2020) conducted an RCT in Difficult spinal anatomy requiring spinal anesthesia (n=156). Preprocedural ultrasonography vs. Conventional landmark-guided palpation was evaluated on Successful access to the subarachnoid space on initial needle insertion attempt (p=0.008). Preprocedural ultrasonography significantly increased the rate of successful access to the subarachnoid space on the first attempt compared to landmark-guided palpation (74.4% vs 53.8%) in elderly patients with difficult anatomy.
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