Real-time ultrasound guided spinal anesthesia versus conventional technique for orthopedic knee surgery: a randomized controlled trial

Abstract Background: Ultrasound imaging skills are valuable for enhancing the safety of different puncture techniques supported with the fact that the developments in imaging quality have significantly improved our understanding of spinal sonoanatomy. Today, ultrasound imaging has been used to assist or guide central neuroaxial blocks, however, the data about the use of real time guided ultrasound neuroaxial blocks are scanty. The study aimed to identify the value of using the real time ultrasound guidance in applying spinal anaesthesia when compared with the conventional landmark guided approach, regarding the efficiency of the anesthetic technique and incidence of associated common complications. Methods: This randomized controlled trial included 178 patients scheduled for elective Knee orthopedic surgeries under spinal anesthesia in El Kasr Al-Aini Hospital, Cairo University were enrolled in the study. Patients were randomly assigned into conventional group in which 89 patients received landmark guided paramedian spinal anesthesia and ultrasound group in which 89 patients received real time ultrasound guided paramedian spinal anesthesia. Results: The mean numbers of puncture attempts, levels and needle redirections between the conventional group and ultrasound group were 1.61±0.83 vs. 1.12±0.36 (p=0.013), 1.15±0.36 vs. 1.06±0.25 (p=0.018) and 2.68±2.75 vs. 1.94±1.93 (p=0.021) respectively. Ultrasound guided group of patients showed significant lower incidence of bloody puncture and paraesthesia after engaging the needle through the dura. Conclusion: Real time ultrasound guiding improved the ease of introducing spinal anesthesia, reduced the number of puncture attempts, number of puncture levels, number of needle redirections, and incidence of complications.