Anesthesia, Spinal, Scoliosis, Ultrasonography
Conditions
Brief summary
Spinal anesthesia can be challenging in patients with lumbar scoliosis or previous lumbar spine surgery. This study aims to evaluate whether the use of the ultrasound-assisted spinal anesthesia reduces the number of passes required to successful dural puncture compared with the conventional surface landmark-guided technique in patients with abnormal spinal anatomy.
Interventions
PROCEDUREUltrasound-assisted paramedian spinal anesthesia
A preprocedural ultrasound scanning will be done, and skin marking will be made. The needle entry point and insertion angle will be determined based on ultrasound scanning. Spinal anesthesia will be performed via paramedian approach.
PROCEDURELandmark-guided spinal anesthesia
Spinal anesthesia will be done using conventional landmark-guided technique.
0.5% heavy bupivacaine will be administered into intrathecal space. The dose of local anesthetic injected for spinal anesthesia will be at the discretion of the attending anesthesiologist. The dose range of intrathecal bupivacaine will be between 12 and 16 mg.
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients scheduled to undergoing elective orthopedic surgery under spinal anesthesia, * with ASA physical status classification I, II, III, * and with (1) or (2) 1. documented scoliosis in preoperative L-S-Spine X-ray (Cobb abgle \> 10 degree) 2. previous history of lumbar spinal surgery
Exclusion criteria
* Patients with contraindication to spinal anesthesia (coagulopathy, local infection, allergy to local anesthetic) * Patients with morbid cardiac diseases * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the number of needle passes | Intraoperative (from the first insertion of needle to patient's skin, until the completion of spinal anesthetic injection) | the number of forward advancements of the spinal needle in a given interspinous space, i.e., withdrawal and redirection of spinal needle without exiting the skin |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time for identifying landmarks | 1 day (time taken for establish the landmark, from start of palpation/US scanning to completion of palpation/scanning) | In group L, time from start of palpation to completion of the process, as declared by the anesthesiologist. In group U, time from placement of the ultrasound probe on the skin to the completion of markings. |
| Time taken for performing spinal anesthetic | Intraoperative (from insertion of the needle to the completion of injection) | time from needle insertion to the completion of injection |
| dermatome level of sensory block | 5, 10, 15 minutes after the completion of spinal anesthetic injection | thoracic dermatome level of sensory block assessed by loss of cold sensation tested with 2% chlorhexidine swab |
| Number of spinal needle insertion attempts | Intraoperative (from the first insertion of needle to patient's skin, until the completion of spinal anesthetic injection) | the number of times the spinal needle was withdrawn from the skin and reinserted |
| Periprocedural pain | Patients will be asked immediately after the completion of spinal anesthesia | 11-point verbal rating scale (0=no pain, 10=most pain imaginable) |
| Periprocedural discomfort score | Patients will be asked immediately after the completion of spinal anesthesia | 11-point verbal rating scale (0=no discomfort, 10=most discomfort imaginable) |
| Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle | Intraoperative (from the first insertion of needle, until the completion of spinal anesthetic injection) | Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle during the spinal anesthesia procedure |
Countries
South Korea
Outcome results
None listed