Ultrasound Assisted versus Landmark Guided Spinal Anesthesia in Patients with  Abnormal Spinal Anatomy

Qaim Ali Bhatty; Waqas Tariq; Muhammad Ahmed raza; Amran hafiz; Muhammad Mohsin  Riaz; Mirza Hamid Beg

doi:10.51253/pafmj.v75i1.8885

Authors

Qaim Ali Bhatty Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Waqas Tariq Department of Anesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Ahmed raza Department of Anesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Amran hafiz Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Muhammad Mohsin Riaz Department of Anesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
Mirza Hamid Beg Department of Anesthesia, Combined Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i1.8885

Keywords:

Abnormal Spinal Anatomy, Landmark Spinal Anesthesia, Ultrasound

Abstract

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.

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