Ultrasound Assisted versus Landmark Guided Spinal Anesthesia in Patients with Abnormal Spinal Anatomy
DOI:
https://doi.org/10.51253/pafmj.v75i1.8885Keywords:
Abnormal Spinal Anatomy, Landmark Spinal Anesthesia, UltrasoundAbstract
Objective: To compare the efficacy of ultrasound assisted versus landmark guided spinal anesthesia in patients with difficult anatomy.
Study Design: Quasi-experimental study.
Place and Duration of Study: Department of Anesthesiology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Mar 2022.
Methodology: We enrolled a total of 70 patients, scheduled for elective lower extremity surgery, under spinal anesthesia for this study. Patients were randomly divided into two groups with the help of random numbers generated using MS Excel. Patients in Group-A, underwent spinal anesthesia using the surface landmark–guided approach (Landmark Group) and in Group-B, patients underwent pre-procedural ultrasound–assisted (Ultrasound Group) technique.
Results: Single puncture and single re-direction rate was found to be significantly higher for patients in Group-B and rate of single attempt (1 attempt: Group-A: 13(37.1%) vs. Group-B: 24(68.6%), p-value=0.031) along with number of needle redirections (1-2 attempt: Group-A: 9(25.7%) vs. Group-B: 23(65.7%), p-value=0.009) was also significantly higher for patients in Group-B. No significant difference in complications was seen between groups. However, Group-A encountered higher frequency of complications as compared to Group-B.
Conclusion: Pre-procedural ultrasound assisted technique is more effective for successful access to subarachnoid space at the first attempt and reduces the number of needle redirections as compared to landmark-guided technique.
Downloads
References
McCombe K, Bogod D. Regional anaesthesia: risk, consent and complications. Anaesthesia 2021; 76: 18-26.
https://doi.org/10.1111/anae.15279
Inanami H, Iwai H, Kaneko T, Oshina M, Manabe N, Takano Y, et al. Relationship between lumbar lordosis and the ratio of the spinous process height to the anterior spinal column height. Sci Rep 2020; 10(1): 1-8. https://doi.org/10.1038/s41598-020-59395-y
Kim H, Won D, Chang J-E, Lee J-M, Ryu J-H, Min S-W, et al. Ultrasound assessment of the anatomic landmarks for spinal anesthesia in elderly patients with hip fracture: a prospective observational study. Medicine 2019; 98(27): e16205.
https://doi.org/10.1097/MD.0000000000016205
Chin K, Perlas A, Chan V. The ultrasound‐assisted paraspinous approach to lumbar neuraxial blockade: a simplified technique in patients with difficult anatomy. Acta Anaesthesiol Scand 2015; 59(5): 668-673.
https://doi.org/10.1111/aas.12493
Li M, Ni X, Xu Z, Shen F, Song Y, Li Q, et al. Ultrasound-assisted technology versus the conventional landmark location method in spinal anesthesia for cesarean delivery in obese parturients: a randomized controlled trial. Anesth Analg 2019; 129(1): 155-161.
https://doi.org/10.1213/ANE.0000000000003681
Geng J, Chen X, Wang X, Guo X, Li M. Ultrasound imaging increases first-attempt success rate of neuraxial block in elderly patients. Zhonghua Yi Xue Za Zhi 2016; 96(43): 3459-3463.
https://doi.org/10.3760/cma.j.issn.0376-2491.2016.43.006
Park S-K, Bae J, Yoo S, Kim WH, Lim Y-J, Bahk J-H, et al. Ultrasound-assisted versus landmark-guided spinal anesthesia in patients with abnormal spinal anatomy: a randomized controlled trial. Anesth Analg 2020; 130(3): 787-795.
https://doi.org/10.1213/ANE.0000000000004640
Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology 2011; 115(1): 94-101.
https://doi.org/10.1097/ALN.0b013e31821a8b4c
Uyel Y, Kilicaslan A. Preprocedural ultrasonography versus landmark-guided spinal anesthesia in geriatric patients with difficult anatomy: A prospective randomized trial. Eurasian J Med 2021; 53(1): 9-14.
https://doi.org/10.5152/eurasianjmed.2021.20190
Qu B, Chen L, Zhang Y, Jiang M, Wu C, Ma W, et al. Landmark-guided versus modified ultrasound-assisted paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial. BMC Anesthesiol 2020; 20(1): 1-11.
https://doi.org/10.1186/s12871-020-01156-7
Ekinci M, Alici HA, Ahiskalioglu A, Ince I, Aksoy M, Celik EC, et al. The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks. J Clin Anesth 2017; 37: 82-85.
https://doi.org/10.1016/j.jclinane.2016.10.031
Bowens C, Dobie K, Devin C, Corey J. An approach to neuraxial anaesthesia for the severely scoliotic spine. Br J Anaesth 2013; 111(5): 807-811. https://doi.org/10.1093/bja/aet239
Srinivasan KK, Iohom G, Loughnane F, Lee PJ. Conventional landmark-guided midline versus preprocedure ultrasound-guided paramedian techniques in spinal anesthesia. Anesth Analg 2015; 121(4): 1089-1096.
https://doi.org/10.1213/ANE.0000000000000847
Lim Y, Choo C, Tan K. A randomised controlled trial of ultrasound-assisted spinal anaesthesia. Anaesth Intensive Care 2014; 42(2): 191-198.
https://doi.org/10.1177/0310057X1404200207
Ansari T, Yousef A, El Gamassy A, Fayez M. Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth 2014; 23(3): 213-216.
https://doi.org/10.1016/j.ijoa.2014.03.005
Chin KJ. Recent developments in ultrasound imaging for neuraxial blockade. Curr Opin Anesthesiol 2018; 31(5): 608-613.
https://doi.org/10.1097/ACO.0000000000000636
Jiang L, Zhang F, Wei N, Lv J, Chen W, Dai Z. Could preprocedural ultrasound increase the first-pass success rate of neuraxial anesthesia in obstetrics? A systematic review and meta-analysis of randomized controlled trials. J Anesth 2020; 34(3): 434-444. https://doi.org/10.1007/s00540-020-02780-8
Arzola C, Mikhael R, Margarido C, Carvalho JCA. Spinal ultrasound versus palpation for epidural catheter insertion in labour: a randomised controlled trial. Eur J Anaesthesiol 2015; 32(7): 499-505.
https://doi.org/10.1097/EJA.0000000000000172
Rizk MS, Zeeni CA, Bouez JN, Bteich NJ, Sayyid SK, Alfahel WS, et al. Preprocedural ultrasound versus landmark techniques for spinal anesthesia performed by novice residents in elderly: a randomized controlled trial. BMC Anesthesiol 2019; 19(1): 1-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Qaim Ali Bhatty, Waqas Tariq, Muhammad Ahmed raza, Amran hafiz, Muhammad Mohsin Riaz, Mirza Hamid Beg

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.