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. 2013:2013:525818.
doi: 10.1155/2013/525818. Epub 2013 Jan 10.

Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach

P H Conroy  1 , C Luyet, C J McCartney, P G McHardy
Affiliations

Real-time ultrasound-guided spinal anaesthesia: a prospective observational study of a new approach

P H Conroy et al. Anesthesiol Res Pract. 2013.

Abstract

Identification of the subarachnoid space has traditionally been achieved by either a blind landmark-guided approach or using prepuncture ultrasound assistance. To assess the feasibility of performing spinal anaesthesia under real-time ultrasound guidance in routine clinical practice we conducted a single center prospective observational study among patients undergoing lower limb orthopaedic surgery. A spinal needle was inserted unassisted within the ultrasound transducer imaging plane using a paramedian approach (i.e., the operator held the transducer in one hand and the spinal needle in the other). The primary outcome measure was the success rate of CSF acquisition under real-time ultrasound guidance with CSF being located in 97 out of 100 consecutive patients within median three needle passes (IQR 1-6). CSF was not acquired in three patients. Subsequent attempts combining landmark palpation and pre-puncture ultrasound scanning resulted in successful spinal anaesthesia in two of these patients with the third patient requiring general anaesthesia. Median time from spinal needle insertion until intrathecal injection completion was 1.2 minutes (IQR 0.83-4.1) demonstrating the feasibility of this technique in routine clinical practice.

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Figures

Figure 1
Figure 1
Typical positioning of the operator, ultrasound transducer and the patient during, real-time ultrasound-guided spinal anaesthesia.
Figure 2
Figure 2
Spine model showing the paramedian oblique transducer orientation (rotated by 45 degrees) used during real-time scanning with a typical ultrasound image.
Figure 3
Figure 3
Ultrasound image showing the paramedian spinal needle insertion path compared with a schematic overlay of the transducer orientation on a spinal model.
See this image and copyright information in PMC

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