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Minerva Anestesiologica 2017 May;83(5):465-73

DOI: 10.23736/S0375-9393.16.11610-4

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Real-time ultrasound-guided spinal anesthesia in patients with predicted difficult anatomy

Hesham ELSHARKAWY 1, 2, Ankit MAHESHWARI 3, Rovnat BABAZADE 4, Anahi PERLAS 5, Sherif ZAKY 6, Loran MOUNIR-SOLIMAN 1

1 Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; 2 Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; 3 Pain Medicine Service, Case Western Reserve University, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; 4 Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; 5 Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, Toronto, Canada; 6 Firelands Regional Medical Center, Sandusky, OH, USA



BACKGROUND: There are limited reports of lumbar neuraxial blocks using real-time US in patients with predicted difficulties. We compared the number of attempts to perform spinal anesthesia using real-time US guidance versus landmark technique in patients meeting predefined criteria for difficult spinal anesthesia. We also compared procedure time, block success, patient satisfaction and difficulty scores between groups.
METHODS: Following institutional review board approval patients scheduled for total hip or knee arthroplasty with expected difficulty to perform spinal anesthesia were included. Number of attempts, block time, success rate, patient satisfaction and difficulty scores were recorded and we conducted the Kruskal-Wallis non-parametric test of difference between the groups.
RESULTS: Thirty-eight patients were enrolled and a total of 32 data sets was analyzed. For number of attempts, we observed no difference between the groups (P<0.83). The US group resulted in marginally higher time to block compared to the control (P<0.0653). The US group resulted in marginally higher satisfaction compared to the control group (P<0.09). The block success rate was 100% in both groups. Anesthesiologists rated the US group procedure more difficult than the control group (χ2=10.85, P<0.0010).
CONCLUSIONS: This trial suggests that real-time US guidance for spinal anesthesia in challenging patients in comparison to the controlled group was completed in longer time, with lower needle insertion attempts, and higher patient satisfaction scores but without statistically significant differences.


KEY WORDS: Color Doppler ultrasonography - Spinal anesthesia - Autonomic nerve block

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