Ultrasound-assisted Versus Conventional Landmark-guided Spinal Anesthesia in Patients With Abnormal Spinal Anatomy

Seoul National University Hospital44 enrolled

Overview

Spinal anesthesia can be challenging in patients with lumbar scoliosis or previous lumbar spine surgery. This study aims to evaluate whether the use of the ultrasound-assisted spinal anesthesia reduces the number of passes required to successful dural puncture compared with the conventional surface landmark-guided technique in patients with abnormal spinal anatomy.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Anesthesia, Spinal Ultrasonography Scoliosis

Interventions

Ultrasound-assisted paramedian spinal anesthesiaPROCEDURE

A preprocedural ultrasound scanning will be done, and skin marking will be made. The needle entry point and insertion angle will be determined based on ultrasound scanning. Spinal anesthesia will be performed via paramedian approach.

Landmark-guided spinal anesthesiaPROCEDURE

Spinal anesthesia will be done using conventional landmark-guided technique.

0.5% heavy bupivacaineDRUG

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.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adult patients scheduled to undergoing elective orthopedic surgery under spinal anesthesia, * with ASA physical status classification I, II, III, * and with (1) or (2) 1. documented scoliosis in preoperative L-S-Spine X-ray (Cobb abgle \> 10 degree) 2. previous history of lumbar spinal surgery Exclusion Criteria: * Patients with contraindication to spinal anesthesia (coagulopathy, local infection, allergy to local anesthetic) * Patients with morbid cardiac diseases * Pregnancy

Locations (1)

Seoul National University Hospital

Seoul, South Korea

Outcomes

Primary Outcomes

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: Intraoperative (from the first insertion of needle to patient's skin, until the completion of spinal anesthetic injection)

Secondary Outcomes

Number of spinal needle insertion attempts

the number of times the spinal needle was withdrawn from the skin and reinserted

Time frame: Intraoperative (from the first insertion of needle to patient's skin, 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: 1 day (time taken for establish the landmark, from start of palpation/US scanning to completion of palpation/scanning)

Time taken for performing spinal anesthetic

time from needle insertion to the completion of injection

Time frame: Intraoperative (from insertion of the needle to the completion of injection)

dermatome level of sensory block

thoracic dermatome level of sensory block assessed by 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

Data from ClinicalTrials.gov

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