Impact of Ultrasound–Assisted Method on Success Rate of Spinal Anesthesia Performed by Novice Trainees: A Retrospective Comparative Study

Abstract

In current practice, single-shot spinal anesthesia has traditionally been performed using the conventional surface-anatomic-Landmark-Guided technique. This “blind” technique has significant critical issues such as a high risk of complications due to the numerous attempts at spinal needle placement and the negative impact on the learning curve of the trainees. Ultrasound-Assisted spinal anesthesia could reduce these critical issues and allow trainees to perform the procedure more easily and with fewer complications for the patient. We performed a before-and-after monocentric retrospective comparative study at the University of Naples “Federico II” (Naples, Italy). Inclusion criteria were as follows: patients aged 18 years or older; ASA physical status between I and IV; and elective orthopedic surgery under single-shot spinal anesthesia performed by supervised trainees between January 2022 and December 2022. In the selected cohort, 88 patients were included in group A (Landmark-Guided spinal anesthesia) and 91 in group B (Ultrasound-Assisted spinal anesthesia). The number of attempts by trainees (p-value < 0.005), procedure performing time (<0.001), and patient discomfort (<0.001) were significantly lower in group B than in group A. Ultrasound-Assisted single-shot spinal anesthesia performed by novice trainees reduces the number of attempts, complication rate, periprocedural pain, and patient discomfort.

A clinical study on spinal anaesthesia with an equal dose and different concentrations of ropivacaine combined with epidural anaesthesia during caesarean section

“…The concentrations in the three groups were as follows: In G1, cerebrospinal uid (CSF) was extracted from 1.3 ml to 1.7 ml, so the concentration was 0.6%; in G2, CSF was extracted from 1.3 ml to 2.0 ml, that is, a concentration of 0.5%; and in G3, CSF was extracted from 1.3 ml to 2.5 ml, that is, a concentration of 0.4%. All patients were placed in the left lateral position, and ultrasound was used [10,11] to locate the L 2 − 3 vertebral space [12]. After the epidural puncture was successfully completed, subarachnoid puncture was performed with a 25G pen-tip SA needle using the intraneedle method, and the injection of SA was completed at the same speed (0.2 ml/s) [13][14][15].…”

Efficacy of therapies for post dural puncture headache

“…Why should it be different in case of accessing the epidural or intrathecal space? While this topic remains discussed in the case in trained experts [ 51 , 52 ], it was shown that it takes less time and tries by trainees to place a spinal cannula and that patients reported a reduced discomfort when using an ultrasound-assisted approach [ 53 ]. Whether this translates into lower PDPH rates, however, needs to be determined.…”