Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass

Chong, Shun-Siang; Nikman, A. Mohd; Saedah, A; Nazaruddin, W H W Mohd; Kueh, Yee Cheng; Lim, Jo Anne; Kamalrujan, H. Shamsul

doi:10.1093/bja/aex108

Cited by 27 publications

(31 citation statements)

References 15 publications

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“…Grau et al [ 45 ] compared real-time US-guided CSE procedure using the parasagittal oblique view with preprocedural US scanning and conventional landmark palpation technique and found that both US-guided techniques significantly reduced the number of needle passes. The advantage of real-time US guidance was also reported in a recent study by Chong et al [ 6 ]. They found that first-attempt success rate was significantly higher when using real-time US-guided spinal anesthesia with the parasagittal oblique view, compared to the palpation-based paramedian approach [ 6 ].…”

Section: Up-to-date Literature Reviewsupporting

confidence: 60%

“…Real-time US-guided spinal anesthesia using in-plane approach based on the parasagittal oblique view can increase first-attempt success rate compared to the landmark-guided paramedian approach technique [ 6 ]. Needle approach from the non-dependent side may lead to dry tap due to gravity, even if the needle tip is placed in the intrathecal space.…”

Section: Us-guided Techniques For Lumbar Neuraxial Blockmentioning

confidence: 99%

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Ultrasonography for lumbar neuraxial block

et al. 2020

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Ultrasonography can be useful to perform a lumbar neuraxial block. It aids in understanding the anatomy of the lumbar spine before the procedure. Pre-procedural ultrasound imaging provides information about the accurate intervertebral level for puncture, optimal needle insertion point, and depth of needle advancement for a successful neuraxial block. The key ultrasonographic views for lumbar neuraxial block include the transverse midline interlaminar and parasagittal oblique views. Ultrasonography can facilitate lumbar neuraxial block in difficult cases, such as the elderly, obese patients, and patients with anatomical abnormality of the lumbar spine. This review elucidates the basics of spinal ultrasonography for lumbar neuraxial block and the current evidence regarding ultrasound-guided neuraxial block in adults.

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Section: Up-to-date Literature Reviewsupporting

confidence: 60%

Section: Us-guided Techniques For Lumbar Neuraxial Blockmentioning

confidence: 99%

Ultrasonography for lumbar neuraxial block

et al. 2020

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“…Chong et al . [ 3 ] and Conroy and colleagues[ 2 ] reported that the time taken for a successful identification of spinal space was 69 and 90 s, respectively, with real-time US-guided procedure. This difference in time may be due to the fact that the procedure in our study was performed only by consultants, who were specifically trained in the US of spinal spaces.…”

Section: Discussionmentioning

confidence: 99%

“…Information on the use of real-time ultrasound (RUS) guided spinal anaesthesia has, to date, been limited to case series and case reports and few prospective observational studies. [ 2 3 ] The RUS permits more accurate estimation of the appropriate needle insertion site and trajectory. There has been no study done to compare the efficacy of RUS-guided spinal anaesthesia, and pre-procedural ultrasound (PUS) guided spinal anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Real-time ultrasound-guided spinal anaesthesia vs pre– procedural ultrasound-guided spinal anaesthesia in obese patients

Ravi

Naik

Joshi

et al. 2021

Indian Journal of Anaesthesia

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Background and Aims: Spinal anaesthesia is conventionally performed using a landmark-guided midline approach. These surface landmarks may be absent, indistinct or distorted in the presence of obesity, previous spinal surgeries, deformities, or degenerative changes associated with ageing. In the present study, we compared the efficacy of real-time ultrasound (RUS)-guided paramedian approach, and pre-procedure ultrasound (PUS) landmark-guided paramedian approach in obese patients. Methods: Eighty patients with body mass index (BMI) >30 kg/m2 were included in the study. The participants were randomly assigned to two intervention groups, i.e., RUS and PUS approach. The primary end point was to attain a successful lumbar puncture. Variables like the number of attempts, the number of passes, the time taken for identifying landmark(s), and time for a successful lumbar puncture(s) were secondary end points and were recorded in both the groups. Results: The median number of attempts were 4 (IQR 2-4) and 2 (IQR 1-2), respectively, in the PUS and RUS group (P-value < 0.001). The median number of passes, the median time for identifying space, and the time for successful lumbar puncture was statistically significantly less in the RUS group, than the PUS group. Conclusion: The time taken for the identification of the space, the number of attempts, number of passes, and the time taken for successful lumbar puncture was more in the PUS group as compared to the RUS group.

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“…While there has been an increasing trend in the use of real-time ultrasound guidance [35][36][37][38], this technique may not have been suitable for the current study, due to the limitations in the operator's dominant hand in the PSO view [38], and the poor quality of the ultrasound image in the TM view [36].…”

Section: Discussionmentioning

confidence: 99%

Preprocedural Ultrasound Guidance for Combined Spinal-Epidural Anesthesia Results in Better Success Rates in Elderly Patients with Hip Fracture: A Randomized Controlled Trial

Zhang

Jiang

et al. 2020

Preprint

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Background: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods: This prospective, single-blind, parallel-group randomized controlled trial included 80 patients (aged ≥ 65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into either the landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.Results: All patients,40 in each group, completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20% and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5% and 85%, respectively (P < 0.001). The number of needle insertion attempts and passes in the landmark group were 2 (1, 2) and 3 (2, 4), respectively; values of 1 (1, 1) and 1 (1, 2) were documented for the ultrasound group (median [interquartile range], all P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a satisfaction score of 4–5 (P = 0.007). Subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.Conclusions: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registration: Chinese Clinical Trial Register, ChiCTR1900020819. Registered January 20, 2019, http://www.chictr.org.cn/showprojen.aspx?proj=34634

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Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass

Cited by 27 publications

References 15 publications

Ultrasonography for lumbar neuraxial block

Ultrasonography for lumbar neuraxial block

Real-time ultrasound-guided spinal anaesthesia vs pre– procedural ultrasound-guided spinal anaesthesia in obese patients

Preprocedural Ultrasound Guidance for Combined Spinal-Epidural Anesthesia Results in Better Success Rates in Elderly Patients with Hip Fracture: A Randomized Controlled Trial

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