title: A randomised controlled trial of ultrasound-assisted spinal anaesthesia.
abstract: Pre-procedural ultrasound scanning has been used to facilitate spinal anaesthesia in patients with difficult anatomical landmarks and shown to improve first-attempt success rates in some studies. We studied whether pre-procedural ultrasound scanning improved first-attempt success rate and decreased time taken for the procedure in the general adult population. In this prospective, randomised controlled trial, 170 American Society of Anesthesiologists 1 to 3 patients aged between 21 and 80 years were recruited. Informed consent was obtained. Patients were randomised into two groups, ultrasound-guided identification of landmarks (Ultrasound Group) and manual palpation of landmarks (Manual Palpation Group). The primary outcome was first-attempt success rate and secondary outcomes were time taken to perform procedure, number of needle redirections, patient satisfaction and complications. The first-attempt success rate was 64% in the Ultrasound Group and 52% in the Manual Palpation Group (P=0.16). Time taken for procedure was shorter in the Ultrasound Group compared to the Manual Palpation Group (2.9±3.6 minutes versus 3.9±3.7 min, P= 0.007). Patient satisfaction was higher in the Ultrasound Group. There were no differences in complications. As there was no statistically significant difference in first-attempt success rates between the two groups, existing evidence for routine pre-procedural scanning for all patients is inadequate. The current use of pre-procedural ultrasound scanning will probably be limited to selected patients where spinal anaesthesia may be technically challenging with conventional methods.
authors.affiliation: Department of Anaesthesia, Changi General Hospital, Singapore.
authors.forename: Y C
authors.initials: YC
authors.lastname: Lim
authors.forename: C Y
authors.initials: CY
authors.lastname: Choo
authors.forename: K T J
authors.initials: KT
authors.lastname: Tan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: spinal anaesthesia; ultrasound