A Comparison of Conventional Landmark Guided Midline Versus Pre-procedure Ultrasound - Guided Paramedian Techniques in Spinal Anesthesia
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 100
- 试验地点
- 1
- 主要终点
- Number of passes
研究概览
简要总结
Multiple passes and attempts while administering spinal anesthesia are associated with a greater incidence of post dural-puncture headache, paraesthesia and spinal hematoma. The investigators hypothesised that the routine use of pre-procedural ultrasound-guided paramedian spinals reduces the number of passes required to achieve enter the subarachnoid space when compared to the conventional landmark-guided midline approach.
详细描述
Spinal anesthesia is widely performed using a surface landmark based 'blind' technique. Multiple passes and attempts while administering spinal anesthesia are associated with a greater incidence of post dural-puncture headache, paraesthesia and spinal hematoma.
Real time and pre-procedural neuraxial ultrasound techniques have been used to improve the success rate of spinal anesthesia. The use of real time ultrasound-guided spinal anesthesia has to date been limited to case series and case reports. Its use may be limited by the requirement for wide bore needles and the technical difficulties associated with simultaneous ultrasound scanning and needle advancement. The use of pre-procedural ultrasound has been shown to increase the first pass success rate for spinal anesthesia only in patients with difficult surface anatomic landmarks.No technique has been shown to improve the success rate of dural puncture when applied routinely to all patients.
Studies on pre-procedural ultrasound-guided spinal techniques are limited to a midline approach using a transverse median view (TM). The parasagittal oblique (PSO) view consistently offers better ultrasound view of the neuraxis compared to TM views. However no studies have been conducted to assess whether these superior PSO views translate into easier paramedian needle insertion.
We hypothesised that the routine use of pre-procedural ultrasound-guided paramedian spinal technique results in less number of passes required to enter the subarachnoid space when compared to the conventional landmark based midline approach.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Participant)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •all consented patients scheduled to undergo elective total knee or total hip arthroplasty under spinal anesthesia were included in the study.
排除标准
- •Patients with contraindications to spinal anesthesia (allergy to local anesthetic, coagulopathy, local infection and indeterminate neurological disease) were excluded from the study.
结局指标
主要结局
Number of passes
时间窗: Up to 45 minutes from the start of insertion of spinal needled for administration of spinal anaesthetic
The number of passes, defined as 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)
次要结局
- Time for identifying landmarks(Up to 10 minutes fraom start of plapating for landmarks - Completed once anethetist declares that markings are complete)
- Time taken for performing spinal anesthetic(Up to 45 minutes from the start of insertion of spinal needled for administration of spinal anaesthetic)
- Incidence of radicular pain(Up to 24 hours after administration of spinal anaesthetic)
- Number of spinal needle insertion attempts(Up to 45 minutes from the start of insertion of spinal needled for administration of spinal anaesthetic)
- Blood in spinal needle(Up to 45 minutes from the start of insertion of spinal needled for administration of spinal anaesthetic)
- Presence of paresthesia(Up to 24 hours after administration of spinal anaesthetic)
- Grading of palpated landmarks(Up to 10 minutes fraom start of plapating for landmarks - Completed once anethetist declares that markings are complete)
- Peri-procedural VAS scores of pain at injection site(up to 30 minutes following spinal anaesthetic injection and prior to sedation)
- peri-procedural discomfort scores(up to 30 minutes following spinal anaesthetic injection and prior to sedation)
- Level of block(15 minutes after spinal anaesthetic injection)
研究者
Karthikeyan Kallidaikurichi Srinivasan
Specialist Registrar,Anaesthetics,Cork University Hospital
Cork University Hospital