title: The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks.
abstract: OBJECTIVE
  The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination.
  
  
  METHODS
  Randomized controlled clinical trial.
  
  
  METHODS
  Operating rooms of university hospital of Erzurum, Turkey.
  
  
  METHODS
  Sixty-four 18- to 45-year-old American Society of Anesthesiologists I-II patients scheduled for cesarean delivery under spinal anesthesia having hardly palpated anatomic landmarks on vertebral column.
  
  
  METHODS
  Palpation difficulty of vertebral column landmarks was scored as 0, 1, 2, or 3 from easy to difficult for all patients in sitting position. The patients with score 2 or 3 were randomly allocated into 2 groups as group C (conventional, n=32) and group U (ultrasound, n=32) in which ultrasound guidance was used.
  
  
  METHODS
  The number of skin punctures, the number of needle steering, the number of puncture tried vertebral levels, and procedure time were all recorded.
  
  
  RESULTS
  The number of skin punctures was significantly lower in group U (P<.001). Successful subarachnoid puncture on first attempt was also significantly higher in group U (P<.01). The duration of procedure in the patients with score 2 was determined to be significantly longer in the ultrasound-guided group (P<.001).
  
  
  CONCLUSIONS
  Ultrasound guidance is an effective and safe method to reduce the number of puncture attempts, improve the success rate of subarachnoid access on the first attempt, and reduce the need to puncture multiple levels, although it prolongs procedure time in patients with score 2 according to our scoring system designed for this current study.
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: murselek@mynet.com.
authors.forename: Mursel
authors.initials: M
authors.lastname: Ekinci
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: haalici@atauni.edu.tr.
authors.forename: Hacı Ahmet
authors.initials: HA
authors.lastname: Alici
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: aliahiskalioglu@hotmail.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Ahiskalioglu
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: ilkerince1983@yahoo.com.
authors.forename: Ilker
authors.initials: I
authors.lastname: Ince
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: dmaksoy@hotmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Aksoy
authors.affiliation: Clinic of Anesthesiology and Reanimation, Palandoken State Hospital, 25080 Palandoken, Erzurum, Turkey. Electronic address: drerkancem@yahoo.com.
authors.forename: Erkan Cem
authors.initials: EC
authors.lastname: Celik
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: adostbil@hotmail.com.
authors.forename: Aysenur
authors.initials: A
authors.lastname: Dostbil
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University Medical Faculty, 25030 Yakutiye, Erzurum, Turkey. Electronic address: mine.celik74@gmail.com.
authors.forename: Mine
authors.initials: M
authors.lastname: Celik
authors.affiliation: Kars State Hospital, Clinic of Anesthesiology and Reanimation, 36100 Merkez, Kars, Turkey. Electronic address: drpinarkaraca@hotmail.com.
authors.forename: Pinar Karaca
authors.initials: PK
authors.lastname: Baysal
authors.affiliation: Kars State Hospital, Clinic of Anesthesiology and Reanimation, 36100 Merkez, Kars, Turkey. Electronic address: birzatemre@windowslive.com.
authors.forename: Birzat Emre
authors.initials: BE
authors.lastname: Golboyu
authors.affiliation: Department of Anesthesiology and Reanimation, Kafkas University Medical Faculty, 36100 Merkez, Kars, Turkey. Electronic address: nur.yeksan@gmail.com.
authors.forename: Ayşe Nur
authors.initials: AN
authors.lastname: Yeksan
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010173:Palpation; D011247:Pregnancy; D011446:Prospective Studies; D011677:Punctures / Q000706:statistics & numerical data; D013131:Spine / Q000033:anatomy & histology*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D055815:Young Adult
keywords: Landmark; Spinal anesthesia; Ultrasound; Vertebral column