US Guided vs Landmark Guided in Paramedian Spinal in Elderly

Abstract Background The ultrasound-assisted paramedian technique reduces the technical difficulty of spinal anaesthesia in the elderly. Compared with the landmark-guided paramedian technique, the use of ultrasound reduced the number of needle manipulations required for success, increased the firstattempt success rate and reduced block-associated pain and discomfort. Aim of the Work The study aims to evaluate whether ultrasound assisted paramedian spinal anaesthesia in the elderly can achieve successful dural puncture with fewer needle passes compared with the conventional landmark guided paramedian technique. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain shams University; this study conducted in the operating theatres of Ain Shams University Hospitals with sample size of 10 patients / group will be needed. The patients randomly divided pre-operatively into two groups using their computer-generated random numbers such that „even numbers‟ will be enrolled in “group-L” for patients receive spinal anaesthesia by the paramedian approach by landmark guided palpation and „odd numbers‟ will be enrolled in “group-s” for patients ultrasound assisted approach. Results Ultrasonography might improve the efficacy of spinal anaesthesia by improving the accuracy of identification of intervertebral level, depth measurement of the intrathecal space and location of the interlaminar window that permits needle passage compared with the landmark guided technique, ultrasound assisted spinal anaesthesia decreases the number of puncture attempts and improves the success rate at the first attempt in patients with potential technical difficulties we believe that individualisation is a key element of minimising technical difficulties. Because of the large intersubject variability in anatomy, the blind technique have a theoretical upper limit of success rate. Through which we obtained success rates of 90 and 100% at the first attempt and within two attempts, respectively, in the ultrasound group. Conclusion Ultrasound-assisted paramedian spinal anaesthesia significantly reduces the number of needle manipulations required for success, increases the success rate at first pass and decreases periprocedural pain and patient discomfort compared with the landmark-guided paramedian technique in the elderly. Our results suggest that the neuraxial ultrasonography enhances the efficacy and comfort of spinal anaesthesia in the elderly.