Preprocedural ultrasound assessment of landmarks of paramedian approach for subarachnoid block in geriatric population

Abstract

Background: Paramedian spinal anesthesia is the preferred anesthetic technique in the elderly. This conventional approach is occasionally challenged by difficulty in identifying landmarks accurately. Neuraxial ultrasound aims to overcome these inaccuracies. Objective: The objective was that the routine use of preprocedural ultrasound assessment of landmarks for paramedian spinal in geriatric population improves the efficacy of spinal anesthesia by reducing the number of attempts and redirections. Materials and Methods: Sixty consenting elderly patients aged 60 year or above, posted for elective surgery under spinal anesthesia, were enrolled in the study. Participants were assigned at random to receive spinal anesthesia by the paramedian approach by either conventional landmark guidance (Group CP) or preprocedural ultrasound-assisted (Group PP) technique. Results: The number of needle redirections was not significant and the success rate at the first attempt with no redirection was higher in the ultrasound compared with the landmark group. However, the mean insertion attempts were indifferent. The preprocedural ultrasound-assisted approach required an insignificantly shorter time for administering spinal anesthesia than the landmark-guided technique (48.87s [67.65] vs. 50.67s [50.19]) [P = 0.90]. The periprocedural pain scores (2.90[2.07] vs. 2.87[1.57]) [P = 0.94] and willingness for a similar future intervention (66.7 vs. 66.7%) were comparable among the groups. Conclusion: The use of preprocedural ultrasonography for paramedian approach to spinal anesthesia is not superior to the conventional landmark guidance in achieving successful dural tap at L3-L4 interspace in elderly adult population and should be limited to a setting with expert operators and selected patients for whom conventional methods may be technically challenging.