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

Abstract

Background and Aims: Spinal anesthesia is the regional technique preferred for cesarean section and is usually administered using the traditional landmark technique. Ultrasonography of the spine appears to be helpful in locating the puncture site and increasing the success rate. The primary objective of this study was to assess the use of ultrasonogram in locating the lumbar interspinous space for spinal anesthesia in laboring parturients brought for elective cesarean section. Material and Methods: Sixty parturients scheduled to undergo elective cesarean section under spinal anesthesia were included in this prospective randomized controlled trial, after obtaining the institutional ethical clearance. In Group I, 30 patients received spinal anesthesia by landmark technique and in Group II, 30 patients underwent ultrasound-guided spinal anesthesia. The statistical analysis was done using SPSS software version 17 (SPSS Inc., Chicago, Illinois, USA) for Microsoft windows. Results: The time taken for spinal in Group I was longer than in Group II (62 ± 18s; 41 ± 11s; P = 0.0001). The number of attempts of needle insertion was significantly less in Group II (group I 1.86 ± 1.04: group II 1.06 ± 0.25). However, the total preparation time (28 8.30 ± 92 vs 804.73 ± 77; P = 0.0001) was more in the ultrasound-guided than in the landmark group. The patients had better satisfaction in group II. Conclusion: Preprocedural ultrasound is a useful tool for successful lumbar puncture in parturients as it minimizes the number of attempts of needle insertion and provides better patient satisfaction.

Recent advances in obstetric anaesthesia and critical care

“…US-guided spinal anaesthesia (SA) increases success at first pass and reduces the number of postoperative complications (postpartum backache and headache) and can be used for difficult spinal and as a routine practice in elective procedures. [ 13 , 14 ]…”

Recent advancements in regional anaesthesia

“…[ 2 ] Randomised controlled trials (RCTs) and case reports have shown that pre-procedural US of the spine in the subarachnoid block and in the epidural catheter placement is particularly useful in obese parturients, parturients in labour, parturients with preeclampsia, and those with morbid obesity, spine disease, kyphoscoliosis, and on anticoagulants. [ 3 – 6 ] Pre-procedural USG in these cases provides information related to identification of the intervertebral levels, determination of needle insertion point, angle of needle trajectory, and depth of needle insertion. Needle insertion point in the midline can be obtained from the transverse interlaminar view with or without parasagittal oblique view.…”