Comparative Study of Preprocedure and Real-Time Ultrasound-guided Combined Spinal Epidural Anesthesia in Obese Patients

Background: It is a great challenge to perform regional anesthesia in obese patients. In general, combined spinal epidural (CSE) anesthesia is performed blindly using the surface landmark of the midline approach. Obesity masks the surface landmark and makes the procedure difficult. Aim: This study aimed to compare the efficacy and ease of the real-time ultrasound (USG)-guided CSE (RUC) and preprocedure USG-guided CSE (PUC) approach in obese patients. Settings and Design: This prospective randomized intervention study was conducted at a tertiary care center. Methods: Eighty patients with the American Society of Anaesthesiologists Grade II and III and a body mass index >30 kg.m − 2 were included in the study, and randomly, they were assigned into two groups: PUC and RUC groups. The main focus of the study was on the initial effort to position an epidural catheter and administer a subarachnoid block effectively. The secondary outcomes included the number of attempts, the number of passes made, the time needed to identify the epidural space (measured in seconds), and the time it took to place the epidural catheter (measured in seconds) successfully. Results: Out of 80 patients, 77 patients were randomly allocated between two groups for the final analysis. The PUC group received 39, and the RUC group received 38 patients. The median number of attempts was 4 [interquartile range (IQR) 2–4] and 2 (IQR 1–2), respectively, in the PUC and RUC groups ( P < 0.001). Compared to the PUC group, the RUC group showed a statistically significant reduction in the median number of passes, the time taken for space identification, and the time required for successful epidural catheter placement. Conclusions: In the comparison between the PUC and RUC groups, the PUC group demonstrated significantly longer durations for space identification, required more attempts, had a greater number of passes, and exhibited a prolonged time for successful epidural catheter placement.