Health Condition 1: null- ASA l-lll patients with age more than 50 years , BMIequal to / more than 30 kg/m2 posted for joint replacement surgeries under combined spinal epidural anaesthesia Health Condition 2: M16- Osteoarthritis of hip Health Condition 3: M17- Osteoarthritis of knee
Conditions
Interventions
Intervention1: Preprocedural use of ultrasound: In group "B" preprocedural use of ultrasound for identifying level of intervertebral space,needle insertion site and Epidural Depth was done. Epidural d
Sponsors
Max Super Speciality hospital
Eligibility
Inclusion criteria
Inclusion criteria: 1. Patients undergoing orthopaedic joint replacement surgeries 2. Patients with age more than 50 years 3. ASA I-III patients 4. Patients able to provide own consent 5. Patients with BMI >= 30 kg/m2
Exclusion criteria
Exclusion criteria: 1. ASA IV - V patients 2. Patients with known hypersensitivity to local anaesthetics 3. Patients with bleeding disorders 4. Patients on anticoagulants 5. Patients with infection at neuraxial blockade site
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Rate of successful epidural block on the first needle insertion attempt in both groups with blind conventional technique and preprocedural use of ultrasoundTimepoint: zero seconds /minutes or few seconds after local infilteration | — |
Secondary
| Measure | Time frame |
|---|---|
| Correlation of depth of the epidural space measured with an Ultrasound and LOR technique.Timepoint: zero seconds / minutes or few seconds after local infilteration;Number of Accidental Dural Puncture by Tuohys needle of Combined Spinal Epidural setTimepoint: at Zero second /minutes or few seconds after local infilteration;Number of failed block A failed epidural was defined as a block providing inadequate analgesia (VAS â?¥ 4/10) despite the following sequential steps: 10 ml bolus of 0.5% Bupivacaine ,Second dose of 10 ml bolus of 0.5% Bupivacaine and third 5mL 2% Lidocaine bolus Timepoint: 10,20 and 30 minutes of initiation of epidural infusion postoperatively and 3.5, 4,4.5 and 5 hours from insertion of epidural catheter In case of failed block, reassessment every 15 minutes;Number of needle insertion attempts required for successful epidural block A needle insertion attempt was defined as needle insertion preceded by complete withdrawal of the Tuohyâ??s needle from the patientâ??s skin.Timepoint: zero sec/min few seconds after local infilteration;Number of needle passes (insertion and redirection attempts) required for successful epidural block A needle redirection attempt was defined as any change in needle insertion trajectory that did not involve complete withdrawal of the needle from the patientâ??s skin. A needle pass was defined either as needle insertion or redirection attempt. Timepoint: Zero seconds/minutes or few seconds after local infilteration;Patient Satisfaction ScoreTimepoint: 3.5,4,4.5 and 5 hours after insertion of epidural catheter;The efficacy of the epidural component of combined spinal epidural anaesthesiaTimepoint: determined by pain relief (VAS) after 30 minutes of initiation of epidural infusion postoperatively after return of toe movements and patient satisfaction after 5 hours of epidural catheter insertion.These were the end points of the study.;Visual Analog ScaleTimepoint: 10.20 and 30 minutes after initiation of Epidural | — |
Countries
India
Contacts
Public ContactDr Arun Puri Guide
Max super Speciality Hospital, A unit of Balaji Medical and Diagnostic Research Centre
Outcome results
None listed