Ultrasound-assisted Versus Conventional Landmark-guided Paramedian Spinal Anesthesia in Elderly Patients
- Conditions
- UltrasonographyAnesthesia, Spinal
- Interventions
- Procedure: Ultrasound-assisted paramedian technique spinal anesthesiaProcedure: Landmark-guided paramedian technique spinal anesthesiaDevice: Ultrasound
- Registration Number
- NCT03316352
- Lead Sponsor
- Seoul National University Hospital
- Brief Summary
Multiple passes and attempts during spinal anesthesia might be associated with a greater incidence of paraesthesia, postdural puncture headache, and spinal hematoma. We hypothesized that the use of a preprocedural ultrasound-assisted paramedian technique for spinal anesthesia in patients with old age would reduce the number of passes required to entry into the subarachnoid space when compared with the landmark-guided paramedian approach. The study participants will be randomized into group L (landmark-guided) and group U (ultrasound-assisted). In group L, spinal anesthesia will be performed via paramedian approach using conventional landmark palpation technique. In group U, a preprocedural ultrasound scan will be used to mark the needle insertion site, and spinal anesthetic will be done via the paramedian approach.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 80
- Elderly patients (age≥60 years) scheduled to undergoing elective orthopedic surgery under spinal anesthesia
- Patients with ASA physical status classification I, II, III
- Patients with contraindication to spinal anesthesia (coagulopathy, local infection, allergy to local anesthetic)
- Patients with morbid cardiac diseases
- Pregnancy
- Patients with previous history of lumbar spine surgery
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Ultrasound-assisted Ultrasound-assisted paramedian technique spinal anesthesia Ultrasound-assisted paramedian technique spinal anesthesia will be performed. A Preprocedural ultrasound scan will be performed for skin marking of entry site of spinal needle. Spinal anesthesia will be performed via paramedian approach using the skin marking site as entry point. 0.5% heavy bupivacaine will be administered into intrathecal space. Ultrasound-assisted Ultrasound Ultrasound-assisted paramedian technique spinal anesthesia will be performed. A Preprocedural ultrasound scan will be performed for skin marking of entry site of spinal needle. Spinal anesthesia will be performed via paramedian approach using the skin marking site as entry point. 0.5% heavy bupivacaine will be administered into intrathecal space. Landmark-guided Landmark-guided paramedian technique spinal anesthesia In these patients, spinal anesthesia will be performed via paramedian approach using conventional landmark palpation technique. Landmark-guided paramedian technique spinal anesthesia will be performed. 0.5% heavy bupivacaine will be administered into intrathecal space. Landmark-guided 0.5% heavy bupivacaine In these patients, spinal anesthesia will be performed via paramedian approach using conventional landmark palpation technique. Landmark-guided paramedian technique spinal anesthesia will be performed. 0.5% heavy bupivacaine will be administered into intrathecal space. Ultrasound-assisted 0.5% heavy bupivacaine Ultrasound-assisted paramedian technique spinal anesthesia will be performed. A Preprocedural ultrasound scan will be performed for skin marking of entry site of spinal needle. Spinal anesthesia will be performed via paramedian approach using the skin marking site as entry point. 0.5% heavy bupivacaine will be administered into intrathecal space.
- Primary Outcome Measures
Name Time Method the number of needle passes from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection 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
- Secondary Outcome Measures
Name Time Method Periprocedural pain from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection 11-point verbal rating scale (0=no pain, 10=most pain imaginable)
Number of spinal needle insertion attempts from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection the number of times the spinal needle was withdrawn from the skin and reinserted
Time for identifying landmarks from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection In group L, time from start of palpation to completion of the process, as declared by the anesthesiologist. In group U, time from placement of the ultrasound probe on the skin to the completion of markings.
Time taken for performing spinal anesthetic from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection time from needle insertion to the completion of injection
Level of block 5, 10, 15 minutes after the completion of spinal anesthetic injection loss of cold sensation tested with 2% chlorhexidine swab
Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle during the spinal anesthesia procedure
Periprocedural discomfort score from the initiation of spinal anesthesia procedure, until the completion of spinal anesthetic injection 11-point verbal rating scale (0=no discomfort, 10=most discomfort imaginable)
Trial Locations
- Locations (1)
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of