Assessment of Increase in Dimensions Within the Acoustic Target Window for Neuraxial Needle Placement in Cross-Legged Sitting Position in Term Pregnancy Using Ultrasonography

Abstract

Background: Neuraxial anesthesia refers to placement of local anesthetic in or around the peripheral nervous system, it includes both spinal, epidural and caudal anesthesia. Spinal anesthesia is a neuraxial anesthesia technique in which local anesthetic is placed directly in the intrathecal space (subarachnoid space) which houses CSF. Aims: To assess the effect of different positions on the dimensions of paramedian target area in pregnant women using Ultrasonography. Methods: This prospective, observational study was conducted at LD Hospital, Govt. Medical College, Srinagar over a period of eighteen months. After obtaining approval from the Institutional Ethical Committee and informed consent of the patients for participation in the study. A total of 47 patients were included as per our inclusion and exclusion criteria. We assessed the increase in dimensions within the acoustic target window for neuraxial needle placement in Cross legged sitting position in term pregnancy using Ultrasonography. The various parameters we observed were age, gestational age, abdominal circumference, labouring status, comorbidities, comfort level of patients in both SP and CLP and increase in dimensions (PLL, LF, ILD) within acoustic target window using ultrasonography. Results: Sonographically visualized length of PLL (mean 20.85), ILD (mean 30.36), LF (mean 12.72) in CLP were significantly greater as compared to SP and this difference was statistically significant (P value <0.001). In addition the comfort level in CLP were significantly greater as compared to SP and this difference is statistically significant (P value <0.001). Conclusion:In conclusion, positioning the patient in Cross legged sitting position in term pregnancy significantly increased the length of PLL, ILD, LF compared to SP, suggesting easier performance of lumbar neuraxial block. Further clinical studies are required to determine if Cross legged sitting position improve the success rate of lumbar neuraxial block for an easier and more efficient insertion.