Spinal Anesthesia Administration
Conditions
Brief summary
Spinal anesthesia depends on being able to locate physical landmarks on a patient's body. In obese patients, the commonly used landmarks may be difficult or even impossible to feel. In addition, the spine can be hidden beneath a layer of fatty tissue. Ultrasound is useful for finding the correct injection site in pregnant patients, but the usefulness of ultrasound has not been adequately evaluated in non-pregnant patients. The potential benefits for obese patients from the use of ultrasound include shortening the duration of the procedure, increasing patient comfort, decreasing the total number of attempts, and aiding in the choice of appropriate needle length for the patient. The investigators hypothesize that there is no difference in time to perform a spinal anesthetic when landmarking with ultrasound as compared to tactile landmarking in patients with BMI \> 35.
Interventions
PROCEDUREUltrasound guidance
The intervention group's interspaces will be determined using the curved linear probe on a Zonare ultrasound using two views.
PROCEDUREPalpation of Tuffier's line
Current clinical practice. Standard of care would have the attending anesthetist palpate the Tuffier's line to pinpoint the appropriate location for the spinal.
PROCEDURESpinal anesthetic
Subcutaneous local infiltration with a 25g needle we be performed prior to the spinal. Neuraxial technique will be attempted midline with a 25 gauge whitacre needle in the sitting position. Spinals will be attempted on either L2-L3, L3-L4, L4-L5 interspaces. The amount and type of local anesthetic/intrathecal narcotic will be left to the discretion of the Anesthetist.
Sponsors
University of Saskatchewan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing surgeries amenable to spinal anesthetic * BMI \>35 * between the ages of 18-85
Exclusion criteria
* Patients with known spinal disease or previous spinal surgery * Pregnant patients * Patients requiring emergent surgeries * Patients in positions other than sitting during neuroaxial anesthesia * Patients with contraindications to neuroaxial anesthesia
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Total time to perform the spinal | From the beginning of palpation or ultrasound to free flow of Cerebral Spinal Fluid (CSF), up to 1 hour. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time from administration of the local anesthetic needle until free flow CSF | Up to 1 hour | — |
| Number of needle redirections | At time of spinal anesthetic administration | — |
| Number of attempts to complete the spinal | At time of spinal anesthetic administration | As measured by new needle puncture sites, according to the anesthetist performing the procedure |
| Number of failed blocks | Up to 15 minutes after administration of spinal anesthesia | Defined as unable to get free flow CSF or inadequate surgical block after administration of neuraxial anesthetic after 15 minutes. |
Countries
Canada
Outcome results
None listed