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

Background and Aims: There are no surveys documenting the existing regional anaesthesia (RA) practices in our country. This nationwide survey aims to record the existing RA practices, identify any lacunae that might exist and project the future direction of evolution. Methods: This online survey consisting of 31 questions was sent to all members of the Indian Society of Anaesthesiologists and addressed participants’ demographic features, central neuraxial block and peripheral nerve block practices, drug selection, RA training and safety measures. The data were analysed using Statistical Package for the Social Sciences version 24.0. All categorical variables were expressed as frequencies and percentages. Results: A total of 2141 responses were received, with participants distributed across the country. Forty-two per cent of the respondents reported that more than 60% of surgeries were performed under RA. Most of the participants use ‘traditional’ test dose for epidural space confirmation. Fifty participants (2.4%) use ultrasound for neuraxial space identification. Twenty per cent of the participants use a checklist for monitoring post-operative epidural analgesia. 6.7% have undergone specialised training in RA. Around 3.5% of the respondents have performed a wrong-side block. 31.4% of the respondents store intralipid in the operating room. Conclusion: The current survey highlights the prevailing practices, various deficiencies in monitoring and the need for RA training programmes. The data accrued can serve as a baseline for future comparison.

Section: Discussionmentioning

confidence: 84%

Regional anaesthesia practices in India: A nationwide survey

Malhotra¹,

Ramachandran²,

Velayudhan³

et al. 2021

“…As the obese patients having BMI more than 30 kgm -2 were included in the study, the real-time US guided SAB resulted in lesser attempts as compared to preprocedural US-guided SAB. [ 3 ]…”

Section: Discussionmentioning

confidence: 99%

“…This might have contributed to the contradictory results in this study as compared to other studies. In the study by Ravi et al ,[ 3 ] the time taken for successful SAB with preprocedural US-guided spinal block was more 288.31 (IQR 251.74-320.19 seconds) as compared to real-time US-guided 264.32 (IQR 251.46-348.31 seconds) in obese patients.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 ] Recently, real-time US-guided SAB has been used with encouraging results by virtue of its improving on the limitations of the preprocedural ultrasonography (USG). [ 3 ] Furthermore, studies have shown that the real-time US-guided technique reduces the chances of error during angulation of the spinal needle as compared to preprocedural US-assisted SAB. [ 4 5 ] Real-time US guidance provides the advantage of taking into account the probable positional changes of the patients, while instituting the SAB.…”

Section: Introductionmentioning

confidence: 99%

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Comparative evaluation of three techniques for paramedian subarachnoid block: Point-of-care preprocedural ultrasound assisted, real-time ultrasound guided and landmark based

Rana

Bhardwaj

Thakur

et al. 2022

Background and Aims: Preprocedural ultrasound (US) assisted and real-time US-guided subarachnoid block (SAB) are useful adjuncts for successful SAB. This study compared the feasibility and efficacy of real-time US-guided SAB with preprocedural US-assisted and landmark-based SAB using paramedian approach. Methods: The study enroled 150 American Society of Anesthesiologists I and II patients, aged 20–65 years, scheduled for lower limb orthopaedic surgery under SAB. In group L (n = 50), the patients underwent landmark-guided SAB utilising paramedian approach. In group P (n = 50), preprocedural US-assisted SAB was instituted and in group M (n = 50) real-time US-guided SAB was administered. The number of needle attempts for a successful SAB was the primary outcome. The secondary outcomes included successful SAB in first attempt, time taken to perform SAB and patients’ satisfaction. Results: The number of attempts for SAB were (mean ± standard deviation = 1.05 ± 0.35, 1.00 ± 0.28, 1.03 ± 0.26) in groups L, P and M, respectively (P = 0.436). The SAB was successful in the first attempt in 82%, 82% and 80% in groups L, P and M, respectively (P = 0.207). The time taken for the successful SAB was more in group M as compared to groups L and P (groups L and M, P = 0.045 and groups P and M, P = 0.004). The patients’ satisfaction score was comparable. Conclusion: Real-time US guidance for spinal anaesthesia resulted in needle attempts comparable to landmark and preprocedural US-assisted SAB in patients with a normal spine. The time required for the completion of the block was more in real-time US-guided SAB.

“…Pre-puncture US has been observed to increase the success rate of the first attempt, tends to reduce the attempts and improves patient satisfaction. [ 7 8 9 10 ]…”

Section: Discussionmentioning

confidence: 99%

Correlation of preprocedural ultrasound estimated epidural depths in transverse median and posterior sagittal oblique view and body mass index with procedural epidural depths in patients scheduled for surgery under lumbar epidural anaesthesia

Rana¹,

Awasthi²,

Verma³

et al. 2021

Background and Aims: Preprocedural lumbar ultrasound (US) is employed for the estimation of epidural depth (ED). This study observed the correlation of preprocedural ED in transverse median (TM), parasagittal oblique (PSO) view, and body mass index (BMI) with procedural ED. Methods: In a prospective study, 100 female patients, aged 40–65 years, with American Society of Anesthesiologists physical status I/II, BMI 18.5–30 kg m− 2 scheduled for surgeries under lumbar epidural blocks were included. In the TM group, preprocedural ultrasonography (USG) was performed in TM view and ED was calculated, whereas in the PSO group, the paramedian sagittal view was used and corresponding markings were done for epidural needle insertion in the midline and paramedian planes, respectively. The primary outcome was the correlation of procedural ED and preprocedural ED in TM and PSO views, respectively. The secondary outcomes included correlation of procedural ED with BMI, comparability of preprocedural, and procedural ED in TM and PSO views. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) v19.0 (International Business Machines, USA). Results: The preprocedural and procedural ED was less in the TM group (4.43 ± 0.75 and 4.44 ± 0.75 cm) in comparison to those in the PSO group (4.86 ± 0.53, 4.90 ± 0.54; P = 0.001). Strong correlation was observed in preprocedural and procedural ED [r 2 = 0.996 and 0.995]. The procedural ED had strong correlation with BMI [r 2 = 0.600, P = 0.001] in the TM group, and weak correlation [r 2 = 0.367] in the PSO group [ P = 0.01]. The procedural ED was comparable to preprocedural ED in TM and PSO groups. Conclusion: Preprocedural US scanning provides an accurate estimate of actual EDs in TM and PSO view.