Visual images to assist in positioning for spinal and epidural anaesthesia

The patients undergoing neuraxial anaesthesia for their hip and knee replacements, were randomised into two groups: The intervention group( Group 2) received standardised verbal instructions along with visual images to assist them to appropriate positioning to enable a spinal block. Following intravenous cannulation and application of standard monitoring, the participants were requested to sit in the upright position on the operating table with their feet resting on a stool, and shoulders gently supported by an assistant. No further assistance in positioning or any verbal prompting was provided by the theatre assistant. No sedative or anxiolytic premedication was administered to the participants, due to possible interference with their comprehension. Anaesthetists were allowed to choose the type, level, and approach of the block, as well as the needle and local anaesthetic used. The anaesthetist prepared the spinal tray and drugs under aseptic conditions, and prepared and draped the patient’s back. A second person started the timer and read out the standardised verbal instructions and showed the visual images (with a model demonstrating one correct and three incorrect positions).The patient then adopted the required position, and the anaesthetist immediately commenced the procedure. A trained independent observer recorded the relevant data.