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Tawfik MM, Tolba MA, Ismail OM, Messeha MM. Ultrasonography versus palpation for spinal anesthesia in obese parturients undergoing cesarean delivery: a randomized controlled trial. Reg Anesth Pain Med 2024; 49:41-48. [PMID: 37188389 DOI: 10.1136/rapm-2022-104272] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/29/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Ultrasonography may facilitate neuraxial blocks in obstetrics. This randomized controlled trial aimed to compare preprocedural ultrasonography with landmark palpation for spinal anesthesia in obese parturients undergoing cesarean delivery. METHODS 280 American Society of Anesthesiologists (ASA) physical status II-III parturients with body mass index ≥35 kg/m2, full-term singleton pregnancy, undergoing elective cesarean delivery under spinal anesthesia, were randomly assigned to two equal groups (ultrasonography and palpation); preprocedural systematic ultrasound approach and conventional landmark palpation were performed, respectively. Patients and outcome assessors were blinded to the study group. All ultrasound and spinal anesthetic procedures were performed by a single experienced anesthesiologist. The primary outcome was the number of needle passes required to obtain free cerebrospinal fluid (CSF) flow. Secondary outcomes were the number of skin punctures required to obtain free CSF flow, success rate at the first needle pass, success rate at the first skin puncture, duration of the spinal procedure, patient satisfaction and incidence of vascular puncture, paresthesia, failure to obtain CSF flow and failed spinal block. RESULTS There were no significant differences in primary or secondary outcomes between the two groups. The median (IQR) of the number of needle passes required to obtain free CSF flow was 3 (1-7) in ultrasonography group and 3 (1-7) in palpation group; p=0.62. CONCLUSIONS Preprocedural ultrasonography did not decrease the number of needle passes required to obtain free CSF flow or improve other outcomes compared with landmark palpation during spinal anesthesia performed by a single experienced anesthesiologist in obese parturients undergoing cesarean delivery. TRIAL REGISTRATION NUMBER NCT03792191; : https://clinicaltrials.gov/ct2/show/NCT03792191.
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Affiliation(s)
- Mohamed Mohamed Tawfik
- Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt
| | - Mohamed Ahmed Tolba
- Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt
| | - Olfat Mostafa Ismail
- Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt
| | - Medhat Mikhail Messeha
- Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt
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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.
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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
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Sharapi M, Afifi E, Al Mawla AM, Yassin MNA, Awwad SA, El-Samahy M. Ultrasound-based Accuro system versus traditional palpation technique for neuraxial anaesthesia: A systematic review and meta-analysis of randomised controlled trials. J Perioper Pract 2023:17504589231215927. [PMID: 38149589 DOI: 10.1177/17504589231215927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
INTRODUCTION This review evaluates the efficacy and safety of Accuro, a handheld ultrasound device, compared to the palpation technique for neuraxial anaesthesia. Accuro provides real-time imaging guidance, potentially improving accuracy and efficiency. METHODS A comprehensive search across six electronic databases identified randomised clinical trials comparing Accuro with palpation for neuraxial anaesthesia. Risk ratios or mean differences with 95% confidence intervals (CIs) were calculated using a random-effects model. Bias risk was evaluated using the Cochrane Risk of Bias tool. RESULTS Five studies (n=369) met the inclusion criteria. Accuro showed a favourable risk ratio for first insertion success (1.44 [95% CI [1.01, 2.05], p=0.05]). It significantly reduced needle skin passes (MD -0.63; 95% CI [-1.05, -0.21]; p<0.01), but not needle redirection (MD -1.31; 95% CI [-2.71, 0.11]; p=0.07). Procedure time was shorter in palpation (MD 127.82; 95% CI [8.68, -246.97]; p=0.04). Four studies had a low risk of bias; one had some concerns. CONCLUSION Accuro can potentially improve success rates and reduce skin passes in neuraxial anaesthesia. Further trials with larger samples are needed, especially in patients with anticipated difficulties.
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Affiliation(s)
| | - Eslam Afifi
- Faculty of Medicine, Benha University, Benha, Egypt
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Carassiti M, Pascarella G, Strumia A, Russo F, Papalia GF, Cataldo R, Gargano F, Costa F, Pierri M, De Tommasi F, Massaroni C, Schena E, Agrò FE. Epidural Steroid Injections for Low Back Pain: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010231. [PMID: 35010492 PMCID: PMC8744824 DOI: 10.3390/ijerph19010231] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 05/03/2023]
Abstract
Low back pain represents a significant socioeconomic burden. Several nonsurgical medical treatments have been proposed for the treatment of this disabling condition. Epidural steroid injections (ESIs) are commonly used to treat lumbosacral radicular pain and to avoid surgery. Even though it is still not clear which type of conservative intervention is superior, several studies have proved that ESIs are able to increase patients' quality of life, relieve lumbosacral radicular pain and finally, reduce or delay more invasive interventions, such as spinal surgery. The aim of this narrative review is to analyze the mechanism of action of ESIs in patients affected by low back pain and investigate their current application in treating this widespread pathology.
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Affiliation(s)
- Massimiliano Carassiti
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
- Correspondence:
| | - Giuseppe Pascarella
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Alessandro Strumia
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.R.); (G.F.P.)
| | - Giuseppe Francesco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.R.); (G.F.P.)
| | - Rita Cataldo
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Francesca Gargano
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Fabio Costa
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
| | - Michelangelo Pierri
- Integrated Sleep Surgery Team UCBM, Unit of Otolaryngology, Integrated Therapies in Otolaryngology, Campus Bio-Medico University of Rome, 00128 Rome, Italy;
| | - Francesca De Tommasi
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.D.T.); (C.M.); (E.S.)
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.D.T.); (C.M.); (E.S.)
| | - Emiliano Schena
- Unit of Measurements and Biomedical Instrumentation, Department of Engineering, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (F.D.T.); (C.M.); (E.S.)
| | - Felice Eugenio Agrò
- Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio-Medico University of Rome, 00128 Rome, Italy; (G.P.); (A.S.); (R.C.); (F.G.); (F.C.); (F.E.A.)
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Abstract
Point of care ultrasound (POCUS) in the field of obstetric anesthesiology, including cardiac, pulmonary, neuraxial, gastric, and airway ultrasound, can facilitate rapid diagnosis, management, and clinical decision-making surrounding common maternal peripartum comorbidities, and obstetric complications. Routine and proficient utilization of POCUS can ultimately aid in anesthesiologists' role as critical care physicians in the multidisciplinary practice on labor and delivery, with potential future research aiming to determine the potential impact on maternal morbidity and mortality.
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Ismail S, Hameed M. Evaluating anesthesia practice for caesarean section: A prospective cross-sectional study from a tertiary care institution of low- and middle-income country. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_103_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Özhan MÖ, Çaparlar CÖ, Süzer MA, Eskin MB, Atik B. Comparison of three sitting positions for combined spinal - epidural anesthesia: a multicenter randomized controlled trial. Braz J Anesthesiol 2020; 71:129-136. [PMID: 33894856 PMCID: PMC9373673 DOI: 10.1016/j.bjane.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background and objectives The aim of this prospective, multi-centered and multi-arm parallel randomized trial was to test the hypothesis that modified sitting positions including hamstring stretch position (HSP) and squatting position (SP) would reduce needle - bone contact events and increase the success rate of combined spinal - epidural anesthesia (CSEA) compared to traditional sitting position (TSP) in patients undergoing total knee or hip arthroplasty. Patients and methods Three hundred and sixty American Society of Anesthesiologists (ASA) I-III patients, aged between 45-85 years were randomly allocated to one of three groups using computer-generated simple randomization: group TSP (n = 120), group HSP (n = 120), and group SP (n = 120). Primary outcome measures were the number of needle-bone contact and success rates. Secondary outcome measure was the ease of interspinous space identification. Results Seven patients in group SP and four of HSP could not tolerate their position and were excluded. Number of needle-bone contact, success rates, and grade of interspinous space identification were similar between groups (p = 1.000). Independent of positioning, the success rates were higher in patients whose interspinous space was graded as easy compared to difficult or impossible (p < 0.001). Success rates reduced, interspinous space identification became more challenging, and number of needle – bone contact increased as patient’s body mass index (BMI) increased (p < 0.001). Conclusion SP and HSP may be used as alternatives to the TSP. BMI and ease of interspinous space identification may be considered important determinants for CSEA success.
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Affiliation(s)
- Mehmet Özgür Özhan
- Private Çankaya Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Ceyda Özhan Çaparlar
- University of Medical Sciences Yildirim Beyazit Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Mehmet Anıl Süzer
- Private Çankaya Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Mehmet Burak Eskin
- University of Medical Sciences Gulhane Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Bülent Atik
- Balikesir University Medical Faculty Health Practice and Research Hospital, Department of Anesthesiology and Reanimation, Balikesir, Turkey.
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Del Buono R, Pascarella G, Costa F, Terranova G, Leoni ML, Barbara E, Carassiti M, Agrò FE. Predicting difficult spinal anesthesia: development of a neuraxial block assessment score. Minerva Anestesiol 2020; 87:648-654. [PMID: 33325214 DOI: 10.23736/s0375-9393.20.14892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Spinal anesthesia is a commonly performed procedure with unpredictable difficulty. The objective of this study was to predict a difficult lumbar spinal anesthesia with clinical elements that are easy to collect. METHODS A questionnaire-based, observational study named NBA, conducted from February 2018 to June 2018. The questions regarded clinical elements and the eventual spinal anesthesia difficulty encountered. A total of 427 questionnaires were filled by the operators. The clinical elements were selected upon literature search and have been integrated with new ones. All the answers were recorded from the anesthesiologist performing the procedure. RESULTS The NBA Score was derived from a total number of 427 questionnaires. Among them, 26 patients had "previous history of difficult spinal anesthesia;" 277 had "spinous processes not visible;" 83 had "spinous processes not palpable;" 77 had "spinal deformities" and 28 had "previous spinal surgery" in the puncture area; 138 patients received lumbar spinal anesthesia in lateral position. There were 328 (76.8%) single puncture successes. Seventy-nine (18.5%) patients required more than one skin puncture to obtain a successful spinal anesthesia. 20 (4.7%) required an alternative anesthesia technique (general anesthesia). Multivariate analysis indicated that each element is a risk factors for difficult spinal anesthesia, except for previous spinal surgery. CONCLUSIONS The combination of more than one element increased the chance of a second skin puncture of more than 50%. This work proposes a simple clinical scoring system predicting the probability of a difficult spinal anesthesia.
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Affiliation(s)
- Romualdo Del Buono
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, Humanitas Mater Domini Hospital, Castellanza, Varese, Italy
| | - Giuseppe Pascarella
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University, Rome, Italy
| | - Fabio Costa
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University, Rome, Italy
| | - Gaetano Terranova
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, ASST Gaetano Pini, Milan, Italy
| | - Matteo L Leoni
- Unit of Interventional Pain Management, G. da Saliceto Hospital, Piacenza, Italy
| | - Enrico Barbara
- Unit of Anesthesia, Resuscitation, Intensive Care and Pain Management, Humanitas Mater Domini Hospital, Castellanza, Varese, Italy
| | - Massimiliano Carassiti
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University, Rome, Italy -
| | - Felice E Agrò
- Unit of Anesthesia, Intensive Care and Pain Management, Campus Bio-Medico University, Rome, Italy
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Uyel Y, Kilicaslan A. Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Patients with Difficult Anatomy: A Prospective Randomized Trial. Eurasian J Med 2020; 53:9-14. [PMID: 33716523 DOI: 10.5152/eurasianjmed.2020.20215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 01/20/2023] Open
Abstract
Objective This study was aimed to determine whether preprocedural ultrasonography (USG) affects the technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis, or previous spine surgery. Materials and Methods This prospective study was conducted in 156 elderly patients scheduled for elective orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique (group P). The primary finding of our study was the rate of successful access to the subarachnoid space on initial needle insertion attempt. Secondary achievements included number of needle insertion attempts, number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia. Results The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P, 3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among the patients in group P than those in group U. No statistically significant difference was found between the groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced complications (p>0.05). Conclusion Our study findings showed that preprocedural neuroaxial USG improves technical performance of spinal anesthesia in elderly patients with difficult anatomy.
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Affiliation(s)
- Yasin Uyel
- Department of Anaesthesiology and Reanimation, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
| | - Alper Kilicaslan
- Department of Anaesthesiology and Reanimation, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey
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Point-of-care ultrasound in pregnancy: gastric, airway, neuraxial, cardiorespiratory. Curr Opin Anaesthesiol 2020; 33:277-283. [DOI: 10.1097/aco.0000000000000846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Bartos A, Breazu CM, Bartos D, Mitre CI. Accidental Spinal Cord Injury Following an Attempted Thoracic Epidural for acute Pancreatitis Pain Management. Turk J Anaesthesiol Reanim 2020; 48:71-74. [PMID: 32076684 PMCID: PMC7001809 DOI: 10.5152/tjar.2019.15564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 05/06/2019] [Indexed: 11/22/2022] Open
Abstract
We report a case of spinal cord injury following an attempted epidural in a conscious woman for pain management in acute pancreatitis. The epidural needle was inserted at the T11–T12 interspace. On the second attempt, dural puncture occurred. The patient did not complain of pain or discomfort during the procedure. Thirty-two hours after the attempted epidural, the patient was found to have motor deficit on her right lower limb. Magnetic resonance imaging showed a spinal haematoma with direct spinal cord injury. Post-laminectomy neurological recovery was slow but progressive. The possible causes for spinal cord injury and spinal haematoma without pain or paraesthesia during the procedure are discussed.
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Affiliation(s)
- Adrian Bartos
- Department of Surgery, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania
| | - Caius-Mihai Breazu
- Department of Anesthesiology and Intensive Care Medicine, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Dana Bartos
- Department of Surgery, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Calin Iosif Mitre
- Department of Anesthesiology and Intensive Care Medicine, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
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Jain K, Puri A, Taneja R, Jaiswal V, Jain A. Preprocedural ultrasound as an adjunct to blind conventional technique for epidural neuraxial blockade in patients undergoing hip or knee joint replacement surgery: A randomised controlled trial. Indian J Anaesth 2019; 63:924-931. [PMID: 31772401 PMCID: PMC6868672 DOI: 10.4103/ija.ija_327_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/08/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIMS The patients undergoing total knee and hip replacement surgeries are mostly obese, more than 50 years of age with osteophytic spine and spine deformities making the blind conventional technique of regional anaesthesia more difficult. The aim of the study was to compare the role of preprocedural ultrasound scan to conventional blind technique in obese patients with osteophytic spines undergoing total knee or hip replacement surgeries in terms of technical difficulty, clinical efficacy, safety and patient comfort. METHODS A prospective, randomised controlled trial was conducted in which 210 consenting American Society of Anesthesiologists (ASA) grade III patients, age >50 years, Body Mass Index (BMI) ≥30 kg/m2 with osteophytic spines including abnormalities undergoing joint replacement surgeries were randomised in two groups. Ultrasound group ("B") received Combined Spinal Epidural Anaesthesia (CSEA) after preprocedural lumbar ultrasound scan. In control group ("A"), CSEA was given by blind conventional technique. The primary objective was to compare the rate of successful epidural block on 1st needle insertion attempts in both the groups. The secondary objectives were to compare both groups in terms of ease, success, comfort and safety of epidural block. RESULTS Ultrasound improved success of CSEA at 1st attempt from 74.3% in control group ("A") to 85.7% in Ultrasound group ("B") (P = 0.038). Fewer needle insertion attempts, passes and anaesthesiologist were required in ultrasound group. Pearson correlation coefficient was 0.976 using both views. CONCLUSION Preprocedural ultrasound scan is a useful adjunct to lumbar epidural blocks in obese patients with osteophytic abnormal spines.
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Affiliation(s)
- Kompal Jain
- Department of Anaesthesiology and Pain Management, Max Superspeciality Hospital, Patparganj, New Delhi, India
| | - Arun Puri
- Department of Anaesthesiology and Pain Management, Max Superspeciality Hospital, Patparganj, New Delhi, India
| | - Rajeev Taneja
- Department of Anaesthesiology and Pain Management, Max Superspeciality Hospital, Patparganj, New Delhi, India
| | - Vikky Jaiswal
- Department of Anaesthesiology and Pain Management, Max Superspeciality Hospital, Patparganj, New Delhi, India
| | - Anant Jain
- Department of Internal Medicine, Westchester Medical Center, New York, USA
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Elsharkawy H, Saasouh W, Babazade R, Soliman LM, Horn JL, Zaky S. Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique. PAIN MEDICINE 2019; 20:1750-1755. [PMID: 30865772 DOI: 10.1093/pm/pnz026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. DESIGN Prospective descriptive trial on a novel approach. SETTING Operating room and preoperative holding area at a tertiary care hospital. SUBJECTS Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. METHODS Consented adult patients aged 30-80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2-5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. RESULTS Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. CONCLUSIONS We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.
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Affiliation(s)
- Hesham Elsharkawy
- Departments of Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, CCLCM of Case Western Reserve University, Cleveland, Ohio
| | - Wael Saasouh
- Department of Anesthesiology, Detroit Medical Center, Detroit, Michigan; Outcomes Research Consortium, Anesthesiology Institute, Cleveland, Ohio
| | - Rovnat Babazade
- Department of Anesthesiology, University of Texas Medical Branch at Galveston, Galveston, Texas.,Outcomes Research Consortium, Cleveland, Ohio
| | - Loran Mounir Soliman
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jean-Louis Horn
- Division of Regional Anesthesia, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, California
| | - Sherif Zaky
- Department of Pain Management, Firelands Regional Medical Center, Sandusky, Ohio, USA
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