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. 2022 Mar;66(Suppl 2):S102-S107.
doi: 10.4103/ija.ija_373_21. Epub 2022 Mar 25.

Comparative evaluation of three techniques for paramedian subarachnoid block: Point-of-care preprocedural ultrasound assisted, real-time ultrasound guided and landmark based

Deepak Bhardwaj  1 , Lokesh Thakur  2 , Shalini Sharma  3 , Shelly Rana  1 , Bhanu Gupta  1 , Charu Sharma  4
Affiliations

Comparative evaluation of three techniques for paramedian subarachnoid block: Point-of-care preprocedural ultrasound assisted, real-time ultrasound guided and landmark based

Deepak Bhardwaj et al. Indian J Anaesth. 2022 Mar.

Abstract

Background and aims: Preprocedural ultrasound (US) assisted and real-time US-guided subarachnoid block (SAB) are useful adjuncts for successful SAB. This study compared the feasibility and efficacy of real-time US-guided SAB with preprocedural US-assisted and landmark-based SAB using paramedian approach.

Methods: The study enroled 150 American Society of Anesthesiologists I and II patients, aged 20-65 years, scheduled for lower limb orthopaedic surgery under SAB. In group L (n = 50), the patients underwent landmark-guided SAB utilising paramedian approach. In group P (n = 50), preprocedural US-assisted SAB was instituted and in group M (n = 50) real-time US-guided SAB was administered. The number of needle attempts for a successful SAB was the primary outcome. The secondary outcomes included successful SAB in first attempt, time taken to perform SAB and patients' satisfaction.

Results: The number of attempts for SAB were (mean ± standard deviation = 1.05 ± 0.35, 1.00 ± 0.28, 1.03 ± 0.26) in groups L, P and M, respectively (P = 0.436). The SAB was successful in the first attempt in 82%, 82% and 80% in groups L, P and M, respectively (P = 0.207). The time taken for the successful SAB was more in group M as compared to groups L and P (groups L and M, P = 0.045 and groups P and M, P = 0.004). The patients' satisfaction score was comparable.

Conclusion: Real-time US guidance for spinal anaesthesia resulted in needle attempts comparable to landmark and preprocedural US-assisted SAB in patients with a normal spine. The time required for the completion of the block was more in real-time US-guided SAB.

Keywords: Anaesthesia; analgesia; point-of-care; spinal; ultrasonography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Consolidated standards of reporting trials (CONSORT) flow chart
Figure 2
Figure 2
Paramedian sagittal oblique view of lumbar spine depicting saw tooth appearance, anterior complex, posterior complex and intrathecal space
Figure 3
Figure 3
The comparative evaluation of number of needle attempts for successful subarachnoid block in the three groups. SD = Standard deviation
Figure 4
Figure 4
The number of needle redirections and first attempt success rate for subarachnoid block in the three groups
Figure 5
Figure 5
Time taken for landmark identification and for successful subarachnoid block in the three groups. SD = Standard deviation
See this image and copyright information in PMC

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