Journal of Kerman University of Medical Sciences

Success Rate of Spinal Anesthesia by Anesthesia Resident: Comparing Ultrasonography Versus Traditional Method, a Randomized Clinical Trial

Document Type : Original Article

Authors

Poupak Rahimzadeh 1
Mohammad Reza Ghodraty 2
Seyed Hamid Reza Faiz 1
Elham Pardis 2
Toktam Yavari 2
Alireza Pournajafian 2

1 Anesthesia Department, Rasool Akram Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Anesthesia Department, Firoozgar Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

https://doi.org/10.22062/jkmu.2022.91945
Abstract
Background: Previous studies have suggested the use of ultrasonography for more success in spinal anesthesia. The purpose of this study was to compare the effect of ultrasonography and traditional method on the success rate of spinal anesthesia by an anesthesia resident.
Methods: In this clinical trial study, patients who were candidate for leg or lower abdominal surgery under spinal anesthesia and referred to Firoozgar and Rasoul-e-Akram hospitals in 2019 were randomly assigned to techniques: 1) common surface marking techniques and 2) the use of ultrasonography to find the spinal canal. The dural puncture success rate at the first needle entry attempt, time required for determining the needle entry site, time required for needle entry until CSF exit, number of needle redirection without complete skin exit, and needle entry after complete needle withdrawal in each group were measured and recorded.
Results: The success rate of dural puncture at the first attempt of entry and the time required to determine the needle entry site in the ultrasonography group (55.2%) was significantly higher than that in Landmark group (21.4%) (P<0.05). The time required for needle entrance to CSF exit, the total procedure time for patients, the number of needles redirection without complete removal of the skin, and the number of needle entry after complete removal of the skin in the ultrasonography group was significantly lower than that in Landmark group (P<0.05).
Conclusion: The use of ultrasonography in comparison with the traditional method has been effective on the success rate of spinal anesthesia by an anesthesia resident.
 

Keywords

Keywords: Ultrasonography
Landmark
Spinal Anesthesia
Surgery
  1. Talati C, Arzola C, Carvalho JC. the use of ultrasonography in obstetric anesthesia. Anesthesiol Clin. 2017; 35(1):35-58. doi: 10.1016/j.anclin.2016.09.005.
  2. Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011; 115(1):94-101. doi: 10.1097/ALN.0b013e31821a8ad4. 
  3. Creaney M, Mullane D, Casby C, Tan T. Ultrasound to identify the lumbar space in women with impalpable bony landmarks presenting for elective caesarean delivery under spinal anaesthesia: A randomised trial. Int J Obstet Anesth. 2016; 28:12-6. doi: 10.1016/j.ijoa.2016.07.007.
  4. Parate LH, Manjunath B, Tejesh CA, Pujari V. Inaccurate level of intervertebral space estimated by palpation: The ultrasonic revelation. Saudi J Anaesth. 2016; 10(3):270-5. doi: 10.4103/1658-354X.170104.
  5. Carvalho JC. Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin. 2008; 26(1):145-58. doi: 10.1016/j.anclin.2007.11.007.
  6. Rahimzadeh P, Faiz SH. Ultrasound a new paradigm in regional anesthesia and pain management. Anesth Pain Med. 2013; 3(2):228-9. doi: 10.5812/aapm.13363.
  7. Li M, Ni X, Xu Z, Shen F, Song Y, Li Q, et al. Ultrasound-Assisted technology versus the conventional landmark location method in spinal anesthesia for cesarean delivery in obese parturients: A randomized controlled trial. anesth analg. 2019; 129(1):155-61. doi: 10.1213/ANE.0000000000003795.
  8. Ekinci M, Alici HA, Ahiskalioglu A, Ince I, Aksoy M, Celik EC, et al. The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks. J Clin Anesth. 2017; 37:82-5. doi: 10.1016/j.jclinane.2016.10.014.
  9. Urfalioglu A, Bilal B, Oksuz G, Bakacak M, Boran OF, Oksuz H. Comparison of the landmark and ultrasound methods in cesarean sections performed under spinal anesthesia on obese pregnants. J Matern Fetal Neonatal Med. 2017; 30(9):1051-6. doi: 10.1080/14767058.2016.1199677.
  10. Geng J, Chen XL, Wang XD, Guo XY, Li M. Ultrasound imaging increases first-attempt success rate of neuraxial block in elderly patients. Zhonghua Yi Xue Za Zhi. 2016; 96(43):3459-63. doi: 10.3760/cma.j.issn.0376-2491.2016.43.004.
  11. Kallidaikurichi Srinivasan K, Iohom G, Loughnane F, Lee PJ. Conventional landmark-guided midline versus preprocedure ultrasound-guided paramedian techniques in spinal anesthesia. Anesth Analg. 2015; 121(4):1089-96. doi: 10.1213/ANE.0000000000000911.
  12. Rizk MS, Zeeni CA, Bouez JN, Bteich NJ, Sayyid SK, Alfahel WS, Siddik-Sayyid SM. Preprocedural ultrasound versus landmark techniques for spinal anesthesia performed by novice residents in the elderly: A randomized controlled trial. BMC Anesthesiology. 2019; 19:208. doi: 10.1186/s12871-019-0882-8.
  13. Elsharkawy H, Maheshwari A, Babazade R, Perlas A, Zaky S, Mounir-Soliman L. Real-time ultrasound-guided spinal anesthesia in patients with predicted difficult anatomy. Minerva Anestesiol. 2017; 83(5):465-73. doi: 10.23736/S0375-9393.16.11610-4.
  14. Turkstra TP, Marmai KL, Armstrong KP, Kumar K, Singh SI. Preprocedural ultrasound assessment does not improve trainee performance of spinal anesthesia for obstetrical patients: A randomized controlled trial. J Clin Anesth. 2017; 37:21-4. doi: 10.1016/j.jclinane.2016.10.034. 

 

 

Journal of Kerman University of Medical Sciences
Volume 29, Issue 3
May and June 2022
Pages 218-225

Home

Editorial Board

Guide for Authors

Submit Manuscript

Guide for Reviewers

Contact Us