A study to compare preprocedural ultrasound versus landmark technique for spinal anesthesia.

The ideal technique for spinal anaesthesia requires successful dural puncture with single spinal needle pass. Spinal anaesthesia is traditionally performed by palpation of bony landmarks to identify the level of needle insertion using the intercristal line as a guide for identifying L4 (4th lumbar vertebrae) or L4-5 space, but in females and patients with higher body mass indices the level may vary to L3 (3rd lumbar vertebrae) or L3-4 space, causing difficulty to predict the level Frequent attempts during lumbar puncture causes cerebrospinal fluid leakage which is associated with increased incidence of Post Dural Puncture Headache (PDPH). Studies have shown that pre-procedural ultrasound facilitates first attempt success rate in elderly patients, hence use of ultrasonography (USG) will decrease the number of attempts and incidence of PDPH by increasing the first attempt success rate. Recently ultrasound imaging has become a popular tool among anaesthesiologists in operation theatres and intensive care units. USG is widely used in operation theatres for nerve blocks but has still taken a backseat when it comes to neuraxial blocks. USG during the neuraxial blocks usually increases procedural duration making the procedure more intricate. Many studies for USG guided paramedian approach are conducted whereas very few studies are done for routine USG guided midline approach, hence the present study “A STUDY TO COMPARE PREPROCEDURAL ULTRASOUND VERSUS LANDMARK TECHNIQUE FOR SPINAL ANESTHESIA’’ will be conducted to fill this lacune with the hypothesis that Preprocedural USG reduces the number of attempts, reduces the procedural time, reduces the number of needle punctures and PDPH in patients.