Cesarean Section, Obesity
Conditions
Keywords
Ultrasonography, Spinal anesthesia, Cesarean section, Obesity, Neuraxial anesthesia
Brief summary
Spinal anesthesia is the most commonly used anesthetic technique for cesarean section. However, in obese parturients, identification of the optimal puncture site using anatomical landmark palpation can be challenging because of altered anatomy. Preprocedural ultrasound has been proposed as a tool to improve localization of the puncture site and facilitate neuraxial access. This is a prospective comparative study included 100 obese parturients undergoing cesarean section under spinal anesthesia. Participants were allocated to one of two comparison groups according to the puncture site localization technique: a preprocedural ultrasound group and an anatomical landmark palpation group. The primary outcome is the first-attempt success rate, defined as successful cerebrospinal fluid return after the first needle insertion without needle redirection or a new skin puncture. Secondary outcomes include the number of puncture attempts, needle redirections, need for rescue interventions, incidence of paresthesia and vascular puncture during the procedure, and procedural times.
Detailed description
This prospective comparative study aims to evaluate the effectiveness of preprocedural ultrasound-guided marking compared with the conventional anatomical landmark palpation technique for spinal anesthesia in obese parturients undergoing cesarean section. A total of 100 parturients with a body mass index (BMI) ≥ 30 kg/m² were prospectively allocated to one of two comparison groups according to the puncture site localization technique. In the ultrasound group, the puncture site was identified using preprocedural ultrasound to determine the optimal intervertebral space and needle insertion trajectory. In the landmark group, the puncture site was identified using conventional anatomical landmark palpation. The primary outcome was the first-attempt success rate, defined as successful cerebrospinal fluid return after the first needle insertion without needle redirection or an additional skin puncture. Secondary outcomes included the number of puncture attempts, needle redirections, need for rescue interventions, incidence of paresthesia and vascular puncture during needle insertion, and procedural times (site identification time, puncture time, and total procedure time). This study evaluated whether preprocedural ultrasound-guided marking improves the technical performance of spinal anesthesia compared with conventional anatomical landmark palpation in obese parturients undergoing cesarean section.
Interventions
PROCEDUREUltrasound-guided preprocedural marking
Preprocedural ultrasound is used to identify and mark the optimal puncture site before spinal anesthesia.
PROCEDURELandmark-based palpation
The puncture site is identified using anatomical landmark palpation before spinal anesthesia.
Sponsors
Instituto Nacional Materno Perinatal, Peru
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
Due to the nature of the intervention, blinding of the operators was not feasible.
Intervention model description
Participants were prospectively allocated to one of two comparison groups according to the puncture site localization technique (preprocedural ultrasound marking or anatomical landmark palpation) before spinal anesthesia.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 years * Pregnant women undergoing cesarean section * Body mass index (BMI) ≥ 30 kg/m² at the time of cesarean section * Scheduled for cesarean section under spinal anesthesia
Exclusion criteria
* Congenital spinal deformities * History of spinal surgery * Coagulopathy * Infection at the puncture site * Allergy to local anesthetics * Emergency cesarean section (NICE category 1)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| First-attempt success rate of spinal anesthesia | During the spinal anesthesia procedure | Successful cerebrospinal fluid return after the first needle insertion without redirection. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of puncture attempts | During the spinal anesthesia procedure | Total number of needle insertions required to achieve successful spinal anesthesia |
| Number of needle redirections | During the spinal anesthesia procedure | Number of needle redirections during a single puncture attempt |
| Need for rescue intervention | During the spinal anesthesia procedure | Requirement of assistance by a more experienced operator to complete the procedure |
| Incidence of paresthesia | During the spinal anesthesia procedure | Occurrence of paresthesia during needle insertion |
| Incidence of vascular puncture | During the spinal anesthesia procedure | Occurrence of vascular puncture during needle insertion |
| Total procedure time | During the spinal anesthesia procedure | Time from initial identification of the puncture site to successful cerebrospinal fluid return |
| Puncture time | During the spinal anesthesia procedure | Time from needle insertion to successful cerebrospinal fluid return |
Countries
Peru
Contacts
PRINCIPAL_INVESTIGATOREddisson R Quispe Pilco, MD
National Maternal and Perinatal Institute
Outcome results
None listed