Assessment of Difficult Spinal Anaesthesia Using Pre Procedural Ultrasound Compared With Clinical Methods in Young Patients Undergoing Elective Surgeries

Spinal anesthesia can be challenging in young obese patients and in elderly age group (>65yrs).The surface landmarks observed by clinical palpation can be less helpful in these patients (1-7).The purpose of this study is to do pre procedural ultrasound and clinical examination of the lumbar spine in the same group of patients and comparing them to space finally in which the procedure was performed.The aim is to find out the usefulness of sonography in assessing the difficulty of spinal anesthesia in young patients (<55years).METHODS: Seventy five patients undergoing elective procedures under spinal anesthesia were included in the study.All these patients were assessed clinically and sonographically by different group of anesthesiologists and the best space was chosen in both.This was compared to the difficulty of performing the actual spinal procedure.Patients were then divided into three groups.Group A: In this group clinical and sonographic assessment correlated well with the final space in which spinal anesthesia was performed.Group B: In this group only the clinical assessment correlated with final space in which spinal anesthesia was performed.Group C: In this group only the sonographic assessment correlated with the final space in which spinal anesthesia was performed.The data was statistically computed using paired t test and results were obtained.RESULTS: Most of the patients in the study, were females 42/75 (56%), in the age group< 40 years (65.2%), the average weight of the patients <60 kg (69.2%) and height of 145-160 cm (69.3%).Majority of the patients had a BMI of < 30 kg/m2 (97.3%).Statistical analysis of data from group A vs group B shows significant correlation (P value of 0.0001).Similarly comparing group C vs group A is statistically significant (P value =0.0001).Comparing groups B and C was statistically insignificant (P value = 0.320).But there was significant difference in the time taken for clinical and sonographic examination (P value = 0.0001). CONCLUSION:From this study we interpret, that in patients less than 40 years of age, clinical as well as sonographic examination of lumbar spine were equally good in predicting the correct space.Whereas in patients of age group 41-55years, sonogram gives better correlation for identifying the correct space though it is more time consuming.Hence, we conclude that though ultrasound is more useful in patients aged > 40 years expertise is still needed in using this technique.This calls in for routine use of pre procedural sound screening for all anticipated difficult spinals.