Spinal Anesthesia
Conditions
Keywords
spinal anesthesia, ultrasound, palpation, knee, hip, surgery, intervertebral space
Brief summary
Spinal anesthesia is the technique of choice in patients undergoing total joint arthroplasty at Toronto Western Hospital (UHN). The most significant predictor of the ease of performance of spinal anesthesia is the quality of palpable surface landmarks (the spinous processes of the lumbar vertebrae). These surface landmarks may be absent, indistinct or distorted in many of the patients presenting for total joint arthroplasty. This is because of obesity, previous spinal surgery, scoliosis and degenerative changes of aging. The investigators have shown in a previous study that a pre-procedural ultrasound scan of the spine can reliably identify an appropriate site for needle insertion in spinal anesthesia, and that this results in a high success rate on the first needle insertion attempt (84% vs 61-64% in published studies). The investigators therefore believe that this ultrasound-assisted technique of spinal anesthesia is extremely useful, especially in patients with poor-quality surface landmarks. However there are no published randomized controlled trials to date that compare the efficacy of the ultrasound-assisted technique with the traditional surface landmark-guided technique of spinal anesthesia.
Interventions
PROCEDUREUltrasound guidance
ultrasound imaging
PROCEDUREManual palpation
Manual Palpation of vertebra
Sponsors
University Health Network, Toronto
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Planned spinal anesthesia for elective lower limb surgery; and one or more of the following: 1. Body mass index ≥ 35 kgm-2 2. Scoliosis or other spinal deformity 3. Poorly palpable or impalpable spinous processes
Exclusion criteria
* Patient refusal * Contra-indications to regional anesthesia * Known allergy to local anesthetics * Bleeding diathesis * Inability to provide informed consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The success rate of dural puncture on the first needle insertion attempt. | within 2 hours prior to surgery |
Secondary
| Measure | Time frame |
|---|---|
| number of needle insertions/re-directions; performance time; Pain score; Patient satisfaction; quality of ultrasound image; Correlation between palpation and ultrasound; Correlation between ultrasound and measured depth to i.t. space | within 2 hours prior to surgery |
Countries
Canada
Outcome results
None listed