Comparison of landmark versus pre-procedural ultrasonography-assisted midline approach for identification of subarachnoid space in elective caesarean section: A randomised controlled trial

Abstract

Background and Aims:Identification of subarachnoid space in pregnant patients can pose a great challenge to anaesthesiologists. This study was designed to compare conventional landmark technique with pre-procedural ultrasonography-assisted midline approach for identification of the subarachnoid space in elective caesarean section.Methods:After institute ethics committee approval and written informed consent, 100 parturients scheduled for elective caesarean section under spinal anaesthesia were included in this prospective randomised control trial and divided into Group L (n = 50) (landmark technique) and Group U (n = 50) (ultrasound-guided technique). Parameters such as time taken for the identification of the interspace, distance between skin and dura mater, number of insertion attempts (the primary outcome), number of passes and time taken were recorded in both the groups. Statistical analysis was done using SPSS software 16.Results:Demographic profiles of both groups were comparable. The number of attempts for needle insertion (1.04 ± 0.19 vs. 1.97 ± 0.77), number of passes in the same interspinous space (1.26 ± 0.44 vs. 1.90 ± 0.51) and the total time for successful lumbar puncture (31.90 ± 6.30 vs. 51.80 ± 12.28 s) were significantly less in Group U as compared to Group L, but the time of identification of interspinous space was significantly more in Group U (56.70 ± 13.08 s) as compared to Group L (47.10 ± 10.45 s).Conclusion:Pre-procedural ultrasound is a useful tool for successful lumbar puncture in parturients as it reduces the number of attempts with fewer side effects as compared to conventional landmark technique.

Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

“…Four articles involved 384 patients in the emergency room (ER) undergoing a lumbar puncture [ 20 , 21 , 22 , 23 ], while the remaining 28 articles involved 3031 patients undergoing neuraxial anesthesia. Nine studies examined 1169 patients undergoing epidural anesthesia [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], six studies examined 593 patients undergoing CSE anesthesia [ 33 , 34 , 35 , 36 , 37 , 38 ], and 13 studies examined 1293 patients who underwent spinal anesthesia [ 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Notably, 22 studies concerned obstetric patients.…”

Real-time ultrasound-guided spinal anaesthesia vs pre- procedural ultrasound-guided spinal anaesthesia in obese patients

“…The rate of successful dural puncture during the first needle insertion among the pre-procedural group was similar as in other studies. [ 7 8 9 ] This is an important finding since multiple attempts at needle placement are directly related to incidences of spinal haematoma, post-dural puncture headaches, and trauma to neural structures. Further, the number of needle passes required were also statistically less in the RUS group in comparison to the PUS group.…”

“…This is important because it has been shown that the number of self-reported passes is always lower than the actual number of passes. [ 7 ] Third, the age of our population group was, on average, 59 years and spinal anaesthesia has been shown to be more difficult in older populations compared to the general adult population. [ 8 ] Fourth, we used a paramedian approach to the neuraxis.…”

Comparison of the time taken for subarachnoid block using ultrasound-guided method versus landmark technique for cesarean section – A randomized controlled study

“…In a study by Dhanger et al .,[ 10 ] the time taken for the successful lumbar puncture was lesser in the preprocedural ultrasound group than in the traditional landmark group. In the present study, we found a similar decrease in the time taken for subarachnoid block in the ultrasound group than the landmark group.…”