1
|
Huang P, Singleton MN, Qiao WP. Ultrasound-Assisted Spinal Anesthesia in a Patient with a Preexisting Lumbar Interspinous Spacer: A Case Report. A A Pract 2024; 18:e01772. [PMID: 38569142 DOI: 10.1213/xaa.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
An interspinous spacer is a minimally invasive implantable device for the treatment of lumbar spinal stenosis. The in situ implant may prevent safe and successful spinal anesthesia because its position can obstruct the path of the spinal needle. Lumbar neuraxial ultrasonography has been shown to aid in performance of neuraxial anesthesia in patients with challenging anatomy. Currently, there are no reported cases of ultrasound-assisted spinal anesthesia in patients with interspinous spacers. We present a case in which ultrasonography assisted the successful administration of a spinal anesthetic by avoiding an indwelling lumbar interspinous spacer.
Collapse
Affiliation(s)
- Priscilla Huang
- From the Department of Anesthesiology, Critical Care, & Pain Management, Hospital for Special Surgery, New York, New York
| | | | | |
Collapse
|
2
|
Yang H, Zhang Q, Zhong Z, Sun Y, Gong H, Liu Y, Dai X, Lin L, Luo J, Gong G, Yang Y. Administration of combined spinal epidural anesthesia with ultrasound-assisted positioning in obese patients undergoing open hysterectomy: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e36695. [PMID: 38206749 PMCID: PMC10754612 DOI: 10.1097/md.0000000000036695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Administration of combined spinal epidural anesthesia (CSEA) with traditional landmark-guided positioning can be challenging in patients with high body mass index (BMI). The popularization of ultrasound technology may effectively solve these problems. However, reports on the administration of CSEA ultrasound-assisted positioning in obese populations are relatively limited and have made inconsistent conclusions. We aimed to investigate the ability of ultrasound-assisted positioning to improve the success rate of CSEA in obese patients. METHODS Overall, 118 adult women with a BMI ≥ 30 kg/m2 who scheduled to undergo open hysterectomy and received CSEA were recruited. Finally, 108 patients were enrolled and randomly assigned to 2 groups: the ultrasound-assisted positioning group (group A) and traditional landmark-guided positioning group (group B). Ultrasound-assisted or landmark-guided positioning was employed to locate the puncture interspace before anesthesia. The primary outcomes were the success rate of first attempt and number of attempts. The secondary outcomes were the patient positioning accuracy, positioning time, CSEA operation time, patient-satisfaction scores, anesthesia characteristics, and complications of CSEA. RESULTS The success rate of patient first puncture attempt in group A was significantly higher than that in group B (78.4% vs 52.9%, P = .007). The total number of punctures was lower in group A than that in groups B (average rank 44.54 vs 58.46, P = .005). Using ultrasound positioning as the gold standard, the accuracy of landmark-guided location was only 67%. Positioning time in croup A was longer in group A than that in group B (P = .004), while CSEA operation time spent in Group A was less than that in Group B (P < .001). Patient satisfaction score in group A was significantly higher than that in group B (P = .002). The successful puncture interspace in group A were more likely at L3-4 than that in group B (P = .02). CONCLUSION The success rate of first puncture attempt and positioning accuracy in CSEA with ultrasound-assisted is significantly higher than those based on landmark-guided location in obese patients.
Collapse
Affiliation(s)
- Haihong Yang
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- Department of Anesthesiology, No.950 Hospital, Yecheng, Xinjiang, China
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Qin Zhang
- Outpatient department, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Zuling Zhong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yangyang Sun
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Huaqu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yinghai Liu
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Xuemei Dai
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Lu Lin
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Jingya Luo
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Gu Gong
- Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yongjian Yang
- College of Medicine, Southwest Jiaotong University, Chengdu, Sichuan, China
- Department of Cardiology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| |
Collapse
|
3
|
Zhang Y, Peng M, Wei J, Huang J, Ma W, Li Y. Comparison of ultrasound-guided and traditional localisation in intraspinal anesthesia: a systematic review and network meta-analysis. BMJ Open 2023; 13:e071253. [PMID: 37918920 PMCID: PMC10626869 DOI: 10.1136/bmjopen-2022-071253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 10/19/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES The optimal puncture technique for neuraxial anaesthesia in different populations is unclear. We sought to obtain data from randomised controlled trials comparing the impact of ultrasound-guided technology and traditional positioning technology on the success rate of neuraxial anaesthesia. DESIGN Systematic review and network meta-analysis using study populations, interventions, intervention comparisons, outcome measures and study types. DATA SOURCES PubMed, Embase, Cochrane Library and Web of science were searched until 31 September 2022. ELIGIBILITY CRITERIA We included randomised controlled trials comparing three types of neuraxial anaesthesia: ultrasound-assisted, ultrasound real-time guidance and conventional positioning to describe which neuraxial anaesthesia modality is best for patients and to recommend the appropriate one for different populations. DATA EXTRACTION AND SYNTHESIS Five independent reviewers retrieved, screened and edited included studies using standardised methods. Assess risk of bias using the Cochrane Collaboration and Evidence Project tools. Network meta-analysis was performed using STATA V.15 statistical software. RESULTS Twenty-two studies containing three different interventions were included. The SUCRA values of first-pass success rates for the three neuraxial anaesthesia methods were real-time guidance (82.8%), ultrasound-assisted (67.1%) and traditional positioning (0.1%). Both ultrasound techniques improved first-pass success rates compared with traditional localization, but there was no significant difference between the two. Subgroup analysis showed that the use of real-time ultrasound guidance for neuraxial anaesthesia in pregnant and patients with obesity improved first-pass success rates. Ultrasound-assisted technology can improve first-attempt success rates in older patients with abnormal lumbar spine anatomy. CONCLUSION Compared with conventional positioning, ultrasound guidance technology can improve the first-pass success rate of neuraxial anaesthesia, but there is no significant difference between ultrasound-assisted and real-time guidance technology. The results of subgroup analysis tell us that the most suitable neuraxial anaesthesia method is different for different groups of people. PROSPERO REGISTRATION NUMBER PROSPERO number: CRD42022376041.
Collapse
Affiliation(s)
- Yinzhou Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Mingling Peng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Junying Wei
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jieling Huang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - WuHua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuhui Li
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| |
Collapse
|
4
|
Zheng T, Zheng CY, Yan LP, Guo HL, You Y, Ye P, Hu B, Zheng XC. Comparing the minimum local anesthetic dose of ropivacaine in real-time ultrasound-guided spinal anesthesia and traditional landmark-guided spinal anesthesia: a randomized controlled trial of knee surgery patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1492. [PMID: 34805354 PMCID: PMC8573435 DOI: 10.21037/atm-21-3888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
Background Through previous studies and clinical practice, we have found that real-time ultrasound-guided (UG) spinal anesthesia (SA) and traditional landmark-guided (LG) SA each require a different minimum local anesthetic dose (MLAD) of ropivacaine. For this study, we used Dixon’s up-and-down sequential method to analyze and compare the MLAD of different ropivacaine concentrations required for the UG and LG SA methods. Methods A total of 120 patients undergoing knee surgery were consecutively recruited and randomly divided into four groups (30 patients per group). These groups were categorized as follows: Group I: high ropivacaine ultrasound-guided (HRUG), Group II: low ropivacaine ultrasound-guided (LRUG), Group III: high ropivacaine landmark-guided (HRLG), and Group IV: low ropivacaine landmark-guided (LRLG). SA was established by a bolus administration of up-and-down doses of 0.75% or 0.5% plain ropivacaine. Initial doses of 16, 18, 12, and 14 mg were administered to groups I–IV, and after that, increased or decreased by 1.5 mg according to dose effectiveness. Upon identifying the intervertebral puncture level, a lumbar X-ray was performed with metal markers, and actual radiographic findings were identified and compared to the initial markings. Results For UG groups, the MLAD in the LRUG group was significantly higher than in the HRUG group [20.192 mg (95% CI, 19.256–21.174) versus 17.176 mg (95% CI, 16.276–18.124), respectively; P<0.001]. For LG groups, the MLAD in the LRLG group was significantly higher than in the HLRG group [14.478 mg (95% CI, 13.364–15.500) versus 13.201 mg (95% CI, 11.959–14.571), respectively; P=0.047]. When comparing both high ropivacaine groups (HRGs: I/III) to the low ropivacaine groups (LRGs: II/IV), we found that both UG subgroups (I/II) had a significantly higher MLAD than LG subgroups (III/IV) (P<0.001). US identified L4–5 in up to 90% of cases. Comparatively, palpation was successful in only 33.3% of patients. The rates of cephalad localization by US and palpation were 6.67% vs. 66.67%, respectively (P=0.002). Conclusions We found a higher MLAD of ropivacaine was required for UG SA at the L4–5 level due to the method providing a more accurate (less cephalad) localization than traditional LG SA. Trial Registration Chinese Clinical Trial Registry ChiCTR2000033158.
Collapse
Affiliation(s)
- Ting Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Chun-Ying Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fuzhou, China
| | - Lai-Peng Yan
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Orthopedics, Fujian Provincial Hospital, Fuzhou, China
| | - Hui-Ling Guo
- Department of Orthopedics, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Orthopedics, Fujian Provincial Hospital, Fuzhou, China
| | - Yi You
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Peng Ye
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Bin Hu
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
| | - Xiao-Chun Zheng
- Department of Anaesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.,Department of Anaesthesiology, Fujian Provincial Hospital, Fuzhou, China.,Emergency Department, Fujian Emergency Medical Center, Fujian Provincial Hospital, Fuzhou, China
| |
Collapse
|
5
|
Chen L, Huang J, Zhang Y, Qu B, Wu X, Ma W, Li Y. Real-Time Ultrasound-Guided Versus Ultrasound-Assisted Spinal Anesthesia in Elderly Patients With Hip Fractures: A Randomized Controlled Trial. Anesth Analg 2021; 134:400-409. [PMID: 34724678 DOI: 10.1213/ane.0000000000005778] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditional landmark-guided spinal anesthesia can be challenging in elderly patients with hip fractures. Ultrasound assistance (USAS) and real-time ultrasound guidance (USRTG) techniques can facilitate lumbar neuraxial blocks. However, it remains undetermined which method is optimal for use in elderly patients. This study aimed to evaluate which technique was associated with a higher success rate of spinal anesthesia in elderly patients with hip fractures: USAS or USRTG technique. METHODS A total of 114 elderly patients (≥70 years of age) with hip fractures were randomly assigned to receive spinal anesthesia using either the USAS or USRTG technique. The primary outcome was the first-attempt success rate, analyzed using the χ2 test. Secondary outcomes included first-pass success rate, the number of needle attempts and passes, locating time, procedure time, total time, adverse reactions and complications, patient satisfaction, and procedural difficulty score. RESULTS The first-attempt success rate (80.7% vs 52.6%; 95% confidence interval [CI], for the difference, 11.6-44.6) and first-pass success rate (63.2% vs 31.6%; 95% CI for the difference, 14.2-49) were both significantly higher in the USAS compared with the USRTG group (both P = .001). The number of attempts (1 [1-1] vs 1 [1-3]; P = .001) and median passes (1 vs 3; P < .001) were both significantly lower in the USAS group than in the USRTG group. The USRTG group had a shorter locating time (175 seconds [129-234 seconds] vs 315 seconds [250-390 seconds]; P < .001) but a longer procedure time (488 seconds [260-972 seconds] vs 200 seconds [127-328 seconds]; P < .001) and total time (694 seconds [421-1133 seconds] vs 540 seconds [432-641 seconds]; P = .036). There were no significant differences between the 2 groups with regard to the adverse reactions and complications. More patients in the USAS group had a high satisfaction score of 3 to 5 (P = .008). Overall, anesthesiologists rated the USRTG group procedure as "more difficult" (P = .008). CONCLUSIONS In elderly patients with hip fractures, spinal anesthesia with the USRTG technique is not superior to the USAS technique since it has a lower success rate, longer procedure time, lower satisfaction score, and is more difficult to perform. So USAS technique may be more suitable for elderly patients.
Collapse
Affiliation(s)
- Luying Chen
- From the Guangzhou University of Chinese Medicine
| | | | - Yuling Zhang
- From the Guangzhou University of Chinese Medicine
| | - Bo Qu
- Department of Anesthesiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinyuan Wu
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Wuhua Ma
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| | - Yuhui Li
- Department of Anesthesiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, China
| |
Collapse
|
6
|
Qu B, Chen L, Zhang Y, Jiang M, Wu C, Ma W, Li Y. Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial. BMC Anesthesiol 2020; 20:248. [PMID: 32988366 PMCID: PMC7523368 DOI: 10.1186/s12871-020-01172-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022] Open
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).
Collapse
Affiliation(s)
- Bo Qu
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Luying Chen
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Yuling Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Mengting Jiang
- Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Caineng Wu
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China
| | - Yuhui Li
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, China.
| |
Collapse
|