Real-time Ultrasound-guided Spinal Anesthesia:A Feasibility Study

Sunnybrook Health Sciences Centre

Status: Completed

Conditions: Ultrasound Spinal Anesthesia

Treatments: Procedure: Real-time ultrasound guided spinal anesthesia

Study type: Observational

Funder types: Other

Identifiers

NCT01326988

Real-time Spinal Ultrasound

Details and patient eligibility

About

The traditional landmarks to locate the injection site and orientation of the spinal needle for spinal anesthesia are based on palpation of surface bony landmarks. However the actual injection target into the CSF is located at an unknown depth inside the patients 3 dimensional spinal anatomy which can itself vary in its orientation relative to these surface markers.Also bony surface markers may not be palpable in some patients or the patient may have altered spinal alignment. Thus an already blind procedure can become even more misguided involving multiple trial and error needle insertions. On the other hand ultrasound allows visualisation of deep target structures which are impalpable, it allows assessment of spinal alignment and thus directs the orientation of the seeking needle more accurately. Performing US in real-time during needle insertion gives continuous feedback about the correct needle approach path which should reduce the number of blind needle passes.

Enrollment: 100 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria:

• Consenting patients of at least 18 years of age undergoing spinal anesthesia for elective lower limb surgery

Exclusion Criteria (are as for Spinal anesthesia generally)

• Patient refusal
• Sepsis or local infection at the site of injection
• Hypovolemia
• Coagulopathy (INR ≥1.5, Platelets < 75X 109 /L, anticoagulant therapy)
• Indeterminate neurologic disease
• Increased intracranial pressure
• Local anesthetic allergy
• Infection distinct from the site of injection
• Unknown duration of surgery

Trial design

100 participants in 1 patient group

Patients requiring spinal anesthesia for lower limb surgery

Description:

Patients of at least 18 years of age undergoing spinal anesthesia for elective lower limb surgery will be recruited. Therefore inclusion and exclusion criteria are the same as for traditionally administered spinal anesthesia as below. Additionally we will exclude those patients who are incapable of providing fully informed consent, patients who are currently enrolled in other studies and patients with communication difficulties

Treatment:

Procedure: Real-time ultrasound guided spinal anesthesia