A PROSPECTIVE STUDY TO COMPARE REAL TIME ULTRASOUND GUIDED SPINAL ANAESTHESIA VERSUS ULTRASOUND ASSISTED SPINAL ANAESTHESIA IN PATIENTS POSTED FOR TOTAL HIP REPLACEMENT SURGERY
- Conditions
- Diseases of the musculoskeletal system and connective tissue,
- Registration Number
- CTRI/2024/11/076258
- Lead Sponsor
- DR VIRENDRA KUMAR
- Brief Summary
Spinal anesthesia is frequently used in clinical practice. It is frequently used in various orthopedic surgeries. It has advantages such as rapid onset of action, cost effectiveness, ease of administration and relatively fewer side effects. Spinal anesthesia has a number of advantages, including quick onset, complete blockade, and little effect on cardiopulmonary- nary function, that make it suitable for use in old age group however, performing spinal anesthesia by landmark-guided approach can be challenging in elderly patients posted for total hip replacement surgery due to lumbar degeneration, moderate to severe arthritis of hip(rheumatoid or post traumatic arthritis).1–4 Spinal anesthesia is widely performed using a surface landmark-based “blind†technique in which
Multiple attempts may lead to a higher incidence of complications (e.g., postural puncture headache, paresthesia, hematoma, and infection) and increase patient discomfort and dissatisfaction.5–7 Spinal anesthesia is conventionally performed using a landmark-guided midline approach. Various modifications have been described to reduce the morbidity related to repeated attempts and passes. These include a pre-procedure ultrasound-guided midline approach, real-time ultrasound-guided approach, landmark-guided Para median approach and pre-procedure ultrasound-guided Para median approach. Ultrasound is beneficial only in patients administered a single shot spinal anesthetic who have difficult surface landmarks or abnormal anatomy. There are insufficient data to support the routine use of ultrasound in all patients.
Therefore, novel techniques are needed to improve the success rate of spinal anesthesia for such patients.
Recently, ultrasound has emerged as a way to facilitate lumbar neuraxial blocks, namely, the ultra- sound assistance (USAS) technique and the real-time ultrasound guidance (USRTG) technique. The USAS technique is beneficial for lumbar neuraxial anesthesia, improving technique performance by providing reliable anatomical information.8–10 Previous studies have shown that pre puncture ultrasound scanning can improve success rates, shorten puncture time, reduce needle passes, and increase the efficacy and safety of lumbar neuraxial blocks.2,11–13 However, a problem with the USAS approach is that the needle is advanced blindly and sometimes achieves an ideal trajectory and sometimes not. One possible remedy, reported in recent studies, is the USRTG technique, which provides real-time observation of the trajectory of the needle during the puncture process.14–17 However, the USRTG technique is technically difficult to perform. Since few studies comparing the 2 techniques have been done to date, no clear indication exists of which ultrasound technique is more suitable for use in elderly patients posted for Total Hip Replacement (THR) surgery.
Therefore, this study aimed to compare the first- attempt success rate of both the USAS and USRTG techniques in elderly patients posted for THR surgery. The first-pass success rate, procedure time, adverse reactions and complications, patient satisfaction, and procedural difficulty score were also compared between the 2 techniques.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- All
- Target Recruitment
- 64
Eligible participants are patients more than 65 years of age with American Society of Anesthesiology (ASA) physical status I-III who will be scheduled for elective total hip replacement surgery under spinal anesthesia in the supine position.
BMI more than 30kg/m2, Taking angiotensin converting enzyme inhibitors, Emergency cases Absolute correlative contraindications to spinal anesthesia, Patients with a baseline arterial SBP less than 90mmHg or mean arterial blood pressure (MBP) less than 60 mmHg .
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method first attempt success rates “first-attempt†defined as the needle achieving successful Dural-puncture through a single attempt.
- Secondary Outcome Measures
Name Time Method First pass success rates Number of passes
Trial Locations
- Locations (1)
DEPARTMENT OF ANAESTHESIOLOGY Dr RAM MANOHAR LOHIYA ,IMS LUCKNOW
🇮🇳Lucknow, UTTAR PRADESH, India
DEPARTMENT OF ANAESTHESIOLOGY Dr RAM MANOHAR LOHIYA ,IMS LUCKNOW🇮🇳Lucknow, UTTAR PRADESH, IndiaDR MADHUPrincipal investigator8960328056madhu.k9737@gmail.com