Does Ultrasound Guidance Improve Time to Perform a Spinal or Number of Attempts in Obese Patients?

University of Saskatchewan

Status: Completed

Conditions: Spinal Anesthesia Administration

Treatments: Procedure: Ultrasound guidance; Procedure: Spinal anesthetic; Procedure: Palpation of Tuffier's line

Study type: Interventional

Funder types: Other

Identifiers

NCT01680913

U/S spinals

Details and patient eligibility

About

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.

Enrollment: 67 patients

Sex: All

Ages: 18 to 85 years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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67 participants in 2 patient groups

Spinal with ultrasound guidance

Experimental group

Description:

The intervention group's interspaces will be determined using the curved linear probe on a Zonare ultrasound using two views.

Treatment:

Procedure: Spinal anesthetic

Procedure: Ultrasound guidance

Spinal by palpation of Tuffier's line

Active Comparator group

Description:

Current clinical practice. Standard of care would have the attending anesthetist palpate the Tuffier's line to pinpoint the appropriate location for the spinal.

Treatment:

Procedure: Palpation of Tuffier's line

Procedure: Spinal anesthetic