Multiple passes and attempts during spinal anesthesia might be associated with a greater incidence of paraesthesia, postdural puncture headache, and spinal hematoma. We hypothesized that the use of a preprocedural ultrasound-assisted paramedian technique for spinal anesthesia in patients with old age would reduce the number of passes required to entry into the subarachnoid space when compared with the landmark-guided paramedian approach. The study participants will be randomized into group L (landmark-guided) and group U (ultrasound-assisted). In group L, spinal anesthesia will be performed via paramedian approach using conventional landmark palpation technique. In group U, a preprocedural ultrasound scan will be used to mark the needle insertion site, and spinal anesthetic will be done via the paramedian approach.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
80
Ultrasound-assisted paramedian technique will be used. A preprocedural ultrasound scan will be performed, and skin marking for spinal entry site will be done using ultrasound scan. Spinal anesthesia will be done according to skin marking using ultrasound, via paramedian approach.
Landmark-guided paramedian technique will be used. Spinal anesthesia will be done using conventional landmark-guided paramedian technique.
A preprocedural ultrasound scan will be done using Portable Echocardiography system (Vivid-i, GE healthcare) with 4C-RS convex probe (2.0-5.5 MHz Frequency range).
During spinal anesthesia, 0.5% heavy bupivacaine will be administered into intrathecal space. The dose of local anesthetic injected for spinal anesthesia will be at the discretion of the attending anesthesiologist. The dose range of intrathecal bupivacaine will be between 12 and 16 mg.
Seoul National University Hospital
Seoul, South Korea
the number of needle passes
the number of forward advancements of the spinal needle in a given interspinous space, i.e., withdrawal and redirection of spinal needle without exiting the skin
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
Number of spinal needle insertion attempts
the number of times the spinal needle was withdrawn from the skin and reinserted
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
Time for identifying landmarks
In group L, time from start of palpation to completion of the process, as declared by the anesthesiologist. In group U, time from placement of the ultrasound probe on the skin to the completion of markings.
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
Time taken for performing spinal anesthetic
time from needle insertion to the completion of injection
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
Level of block
loss of cold sensation tested with 2% chlorhexidine swab
Time frame: 5, 10, 15 minutes after the completion of spinal anesthetic injection
Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle
Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle during the spinal anesthesia procedure
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
Periprocedural pain
11-point verbal rating scale (0=no pain, 10=most pain imaginable)
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
Periprocedural discomfort score
11-point verbal rating scale (0=no discomfort, 10=most discomfort imaginable)
Time frame: from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection
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