Pre-procedure ultrasound guided paramedian spinal anaesthesia at L5-S1 – is this better than landmark guided midline approach? - a randomized control trial.
Abstract
Introduction
We hypothesised that the routine use of pre-procedural ultrasound-guided paramedian spinals at L5S1 interspace could reduce the number of passes required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach.
Methods
After local ethics approval, 120 consenting patients scheduled for elective total joint replacements (Hip and Knee) were randomised into either group C (conventional) or group P (pre-procedural ultrasound guided paramedian L5S1 technique) with 60 in each group. The patients were blinded to the study group. Midline approach with palpated landmarks was used in group C whereas in group …show more content…
A patient in the paramedian group L5/S1 had an expected number of passes equal to 1.195 times (95% CI 0.57, 2.47) that of a patient in the conventional group (P = 0.63), i.e., similar number of passes were expected in both groups. A patient in the paramedian group L5/S1 had an expected number of attempts equal to 1.079 times (99% CI 0.41, 2.8) that of a patient in the conventional group (P = 0.84), i.e., a similar number of attempts were expected in both groups. The first pass success rates (1 attempt and 1 pass) was significantly greater in group C compared to group P (43% vs 22%, p = 0.02, table 3). Patients in group P had difficult surface landmarks compared to group C (P = 0.04).
Conclusion
Routine use of paramedian spinal anesthesia at L5S1 interspace, guided by pre-procedure ultrasound, in patients undergoing lower limb joint arthroplasties did not reduce the number of passes or attempts needed to achieve successful spinal
Abstract
Introduction
We hypothesised that the routine use of pre-procedural ultrasound-guided paramedian spinals at L5S1 interspace could reduce the number of passes required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach.
Methods
After local ethics approval, 120 consenting patients scheduled for elective total joint replacements (Hip and Knee) were randomised into either group C (conventional) or group P (pre-procedural ultrasound guided paramedian L5S1 technique) with 60 in each group. The patients were blinded to the study group. Midline approach with palpated landmarks was used in group C whereas in group …show more content…
A patient in the paramedian group L5/S1 had an expected number of passes equal to 1.195 times (95% CI 0.57, 2.47) that of a patient in the conventional group (P = 0.63), i.e., similar number of passes were expected in both groups. A patient in the paramedian group L5/S1 had an expected number of attempts equal to 1.079 times (99% CI 0.41, 2.8) that of a patient in the conventional group (P = 0.84), i.e., a similar number of attempts were expected in both groups. The first pass success rates (1 attempt and 1 pass) was significantly greater in group C compared to group P (43% vs 22%, p = 0.02, table 3). Patients in group P had difficult surface landmarks compared to group C (P = 0.04).
Conclusion
Routine use of paramedian spinal anesthesia at L5S1 interspace, guided by pre-procedure ultrasound, in patients undergoing lower limb joint arthroplasties did not reduce the number of passes or attempts needed to achieve successful spinal