Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

Abstract

Background Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods This prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation. Results Eighty patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20 and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5 and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1 [1]) than landmark-guided group (2 [1, 2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1 [1, 2]) than in landmark-guided group (3 [2, 4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4–5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis. Conclusions Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice. Trial registration Chinese Clinical Trial Register (identifier, ChiCTR1900020819; date of registration, January 20, 2019).

Comparative evaluation of three techniques for paramedian subarachnoid block: Point-of-care preprocedural ultrasound assisted, real-time ultrasound guided and landmark based

“…In a recent study, the first attempt success rate was 42.5% and 85% in landmark and US-guided preprocedural groups, respectively. [ 8 ] Nevertheless, in both the above-mentioned studies, patients with a difficult spinal anatomy were enroled, thereby the preprocedural US-assisted SAB resulted in better first attempt success rate as compared to our study. [ 7 8 ]…”

“…[ 8 ] Nevertheless, in both the above-mentioned studies, patients with a difficult spinal anatomy were enroled, thereby the preprocedural US-assisted SAB resulted in better first attempt success rate as compared to our study. [ 7 8 ]…”

“…However, in a study comparing landmark versus US-assisted paramedian techniques in combined spinal-epidural anaesthesia in elderly patients with hip fractures, it was observed that 90% of the patients in the US group had satisfaction scores of 4 to 5 as compared to 65% in the landmark group. [ 8 ] The patients in the study belonged to elderly age groups, contributing to the higher patient satisfaction rate with US-assisted SAB when compared to landmark-based technique as SAB has been shown to be more difficult in elderly patients.…”

Using Lumbar X-Ray to Facilitate Modified Taylor’s Approach of Spinal Anesthesia in an Elderly Patient With Scoliosis

“…Direct ultrasonographic visualization of the interspace has been successfully used to aid neuraxial anesthesia for the obese, elderly patients, or patients with abnormal anatomical surface landmarks. Ultrasonography enhances precision and efficacy for needle insertion [ 17 , 18 ], increases first-attempt success rates, and reduces needle insertion attempts. Point-of-care ultrasonographic guidance has limitations pertaining to equipment availability and provider experience [ 18 ].…”

Correction to: Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

“…Following publication of the original article [ 1 ], the authors reported two errors one in the Abstract section and one in the Result section.…”