Ultrasound-guided evaluation of the lumbar subarachnoid space in lateral and sitting positions in pregnant patients to receive elective cesarean operation

Abstract

Background and Objective:The aim was to compare visibility of the spinal space in sitting and lateral positions, number of attempts, spinal needle depth, skin-dura mater distance and the possible complications; in application of spinal anesthesia, using ultrasound in pregnant patients scheduled to receive elective cesarean operations.Methods:The study was conducted prospective-randomly after receiving approval from the ethics committee and the patients’ permission. ASA I-II 50 pregnant patients were divided into two groups. The patients in Group SP were those placed in a sitting position and the patients in Group LP were those placed in a lateral position. In both groups, the skin-dura mater distance was recorded through an out-of plane technique accompanied by ultrasound. The depth of the spinal needle was measured. The number of attempts, the level of attempts recorded. The degree of visibility of the vertebral space was observed through ultrasound and was numerically scored. Intraoperative and postoperative complications were recorded.Results: There was no difference between the number of attempts, Modified Bromage Scale and mean measurements of skin-dura mater distance observed through ultrasound. The mean needle depths of Group LP were statistically found significantly higher than Group SP (p=0.002).Conclusion:Our study supports the notion that access to the skin-dura mater distance is longer in the lateral decubitus position when skin-dura mater distance is evaluated by measuring needle depth.

Recommendations on the Use of Ultrasound Guidance for Adult Lumbar Puncture: A Position Statement of the Society of Hospital Medicine

“…One randomized study comparing ultrasound-guided spinal anesthesia in a lateral decubitus versus sitting position found no difference in the number of needle insertion attempts or measurement of the skin-dura distance; however, the needle insertion depth was 0.73 cm greater in a lateral decubitus vs sitting position (P = .002). 66 Procedural success rates of LP with ultrasound guidance have not been directly compared in a sitting versus lateral decubitus position, although the overall procedural success rates were higher in one study that allowed the operator to choose either sitting or lateral decubitus position when ultrasound was used. 32…”