Pre- Procedure Paramedian Ultrasound-Guided versus Anatomical Landmarks Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Surgeries

Abstract

Background: Ultrasonography is considered a useful technique for lumbar
neuraxial block. The usage of ultrasonography has a potential in finding the best
route through the anatomy of the lumbar vertebrae. The current study aims to
compare between pre-procedure paramedian ultrasound- guided and anatomical
landmarks spinal anesthesia in elderly undergoing lower limb surgeries in Zagazig
University hospitals.
Methods: This prospective clinical trial study included 72 patients that were divided
randomly into two equal groups, Group C: spinal anesthesia was given by the
paramedian anatomical landmarks-guided technique and Group S: spinal anesthesia
was given by pre-procedure paramedian ultrasound-guided technique.
Results: There was a statistical significance decrease in mean arterial blood pressure
at 5, 10 and 15 min after the onset of spinal anesthesia compared to the baseline
readings within each group (p-value <0.05) . While the heart rate is not significantly decreased compared to the baseline (p-value >0.05). The rate of dural puncture
success on the 1st needle insertion trial was higher in group S compared with group
C (p-value <0.05). The number of needle insertion attempts , needles passes and
needle redirection in this study were significantly lesser in group S than in group C
and the depth was deeper in group C compared to group S (p-value <0.05).
Conclusion: The ultrasound-guided showed significantly decreased number of
successful needle insertion compared with anatomical landmarks spinal anesthesia.
There were remarkable effects on pain reduction and patient satisfaction in elderly
patients. Thus, the current study suggested that usage of ultrasonography had
potential effect in guiding spinal anesthesia.