Key result
Ultrasound-guided paramedian approach improves first-puncture success by ~7% vs median approach in obese cesarean patients.
Why the study?
Combined spinal epidural anesthesia (CSEA) is difficult to perform in obese parturients due to positioning challenges, necessitating comparison of different ultrasound-guided approaches.
Does the paramedian approach to CSEA improve first puncture success rate and reduce complications compared to the median approach in obese patients undergoing cesarean delivery?
RCT (n=100)
Single-blind
Randomly assigned
No
Does the paramedian approach to CSEA improve first puncture success rate and reduce complications compared to the median approach in obese patients undergoing cesarean delivery?
Absolute Event Rate: 92% vs 86%
p-value: p=0.041
The ultrasound-guided paramedian approach for combined spinal epidural anesthesia in obese cesarean patients improves first puncture success and reduces postanesthesia complications compared to the median approach.
Supports ultrasound-guided paramedian CSEA in obese cesarean patients; extends prior neuraxial evidence to this population.
Background: Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound.Methods: One hundred obese patients (BMI≧30 kg/m2) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First puncture success rate, ultrasonic time needed for positioning and puncture time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, adverse reactions to anesthesia, complications after anesthesia, and patient satisfaction with the epidural puncture were recorded.Results: The first puncture success rate was significantly different between the two groups (92% vs 86%, P <0.05). The positioning time and total puncture time in the paramedian approach group were higher than those in the median approach group (217.7 s vs 201.6 s, P <0.05; 251.3 s vs 247.4 s, P＞0.05). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs 12%, P <0.05), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P <0.05).Conclusion: The ultrasound-guided paracentesis approach for intrauterine spinal anesthesia for cesarean section patients is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction.Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019.
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Zhou et al. (2020) conducted an RCT in Obese pregnant women undergoing elective cesarean section (n=100). Ultrasound-guided paramedian approach to combined spinal epidural anesthesia vs. Ultrasound-guided median approach was evaluated on Rate of successful dural puncture on the first attempt (p=0.041). The ultrasound-guided paramedian approach for combined spinal epidural anesthesia significantly improved the first puncture success rate compared to the median approach (92% vs 86%, P=0.041) in obese patients undergoing cesarean delivery.
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