Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery

Title: Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery. Background: Real-time ultrasound-guided neuraxial blockade remains a largely experimental technique. We investigated if this technique might imp...

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Main Author:	Soon Eu, Chong
Format:	Thesis
Language:	English
Published:	2015
Subjects:	RD Surgery
Online Access:	http://eprints.usm.my/40138/1/Dr._Chong_Soon_Eu-24_pages.pdf
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spelling	my-usm-ep.401382018-05-22T00:52:56Z Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery 2015 Soon Eu, Chong RD Surgery Title: Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery. Background: Real-time ultrasound-guided neuraxial blockade remains a largely experimental technique. We investigated if this technique might improve the approach of spinal anaesthesia in different aspects. Objectives: To compare the clinical efficacy of real-time ultrasonographic localization of the intrathecal space by comparing success rate, first needle pass and immediate complications. Methods: 60 patients with BMI less than 30 kg/m2 undergoing lower limb surgery under spinal anaesthesia were recruited. Following palpation and a pre-procedural ultrasound scan, a spinal needle introducer was inserted in-plane to the ultrasound probe. The angle of introducer was adjusted in real-time until it pointed in between two vertebral laminae. A 25G Pencan spinal needle was inserted. Successful dural puncture was confirmed by backflow of cerebrospinal fluid. This was compared to paramedian spinal anaesthesia via palpation method. Results: There were no differences in age, weight, height, BMI, or ASA grading between the two groups. Successful dural puncture on first skin puncture was significantly higher in the ultrasound group than palpation group (86.7% vs. 43.3%, P<0.01). The success rate of single needle pass was also significantly higher in the ultrasound group (46.7% vs. 20%, p=0.028). Among the overweight (BMI>25) patients, dural puncture was successful on the first skin puncture in 17 patients (85%) in ultrasound group vs. 6 patients (33.3%) in palpation group. (p=0.001). Successful rate of single needle pass was also significant in ultrasound group (50% vs. 16.7%, p = 0.033). Amongst patients with BMI<25, there were no significant difference in both groups. Duration taken for determining puncture site was (0.69+1.01) minutes in the ultrasound group and (1.60+1.19) minutes in the palpation group. (p=0.002). Conclusion: Real-time ultrasound-guidance improves the success rate of paramedian spinal anaesthesia in lateral position, especially in overweight patients. It has not much of role in patients who are thin and have easily palpable spinous process. 2015 Thesis http://eprints.usm.my/40138/ http://eprints.usm.my/40138/1/Dr._Chong_Soon_Eu-24_pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RD Surgery
spellingShingle	RD Surgery Soon Eu, Chong Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
description	Title: Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery. Background: Real-time ultrasound-guided neuraxial blockade remains a largely experimental technique. We investigated if this technique might improve the approach of spinal anaesthesia in different aspects. Objectives: To compare the clinical efficacy of real-time ultrasonographic localization of the intrathecal space by comparing success rate, first needle pass and immediate complications. Methods: 60 patients with BMI less than 30 kg/m2 undergoing lower limb surgery under spinal anaesthesia were recruited. Following palpation and a pre-procedural ultrasound scan, a spinal needle introducer was inserted in-plane to the ultrasound probe. The angle of introducer was adjusted in real-time until it pointed in between two vertebral laminae. A 25G Pencan spinal needle was inserted. Successful dural puncture was confirmed by backflow of cerebrospinal fluid. This was compared to paramedian spinal anaesthesia via palpation method. Results: There were no differences in age, weight, height, BMI, or ASA grading between the two groups. Successful dural puncture on first skin puncture was significantly higher in the ultrasound group than palpation group (86.7% vs. 43.3%, P<0.01). The success rate of single needle pass was also significantly higher in the ultrasound group (46.7% vs. 20%, p=0.028). Among the overweight (BMI>25) patients, dural puncture was successful on the first skin puncture in 17 patients (85%) in ultrasound group vs. 6 patients (33.3%) in palpation group. (p=0.001). Successful rate of single needle pass was also significant in ultrasound group (50% vs. 16.7%, p = 0.033). Amongst patients with BMI<25, there were no significant difference in both groups. Duration taken for determining puncture site was (0.69+1.01) minutes in the ultrasound group and (1.60+1.19) minutes in the palpation group. (p=0.002). Conclusion: Real-time ultrasound-guidance improves the success rate of paramedian spinal anaesthesia in lateral position, especially in overweight patients. It has not much of role in patients who are thin and have easily palpable spinous process.
format	Thesis
qualification_level	Master's degree
author	Soon Eu, Chong
author_facet	Soon Eu, Chong
author_sort	Soon Eu, Chong
title	Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
title_short	Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
title_full	Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
title_fullStr	Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
title_full_unstemmed	Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
title_sort	comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2015
url	http://eprints.usm.my/40138/1/Dr._Chong_Soon_Eu-24_pages.pdf
_version_	1747820784892510208

Comparison of real-time ultrasound approach to non ultrasound-assissted approach in paramedian lateral spinal anaesthesia for lower limb surgery

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