Lim Y C, Choo C Y, Tan K T J
Department of Anaesthesia, Changi General Hospital, Singapore.
Anaesth Intensive Care. 2014 Mar;42(2):191-8. doi: 10.1177/0310057X1404200205.
Pre-procedural ultrasound scanning has been used to facilitate spinal anaesthesia in patients with difficult anatomical landmarks and shown to improve first-attempt success rates in some studies. We studied whether pre-procedural ultrasound scanning improved first-attempt success rate and decreased time taken for the procedure in the general adult population. In this prospective, randomised controlled trial, 170 American Society of Anesthesiologists 1 to 3 patients aged between 21 and 80 years were recruited. Informed consent was obtained. Patients were randomised into two groups, ultrasound-guided identification of landmarks (Ultrasound Group) and manual palpation of landmarks (Manual Palpation Group). The primary outcome was first-attempt success rate and secondary outcomes were time taken to perform procedure, number of needle redirections, patient satisfaction and complications. The first-attempt success rate was 64% in the Ultrasound Group and 52% in the Manual Palpation Group (P=0.16). Time taken for procedure was shorter in the Ultrasound Group compared to the Manual Palpation Group (2.9±3.6 minutes versus 3.9±3.7 min, P= 0.007). Patient satisfaction was higher in the Ultrasound Group. There were no differences in complications. As there was no statistically significant difference in first-attempt success rates between the two groups, existing evidence for routine pre-procedural scanning for all patients is inadequate. The current use of pre-procedural ultrasound scanning will probably be limited to selected patients where spinal anaesthesia may be technically challenging with conventional methods.
术前超声扫描已被用于帮助解剖标志难以辨认的患者进行脊髓麻醉，并且在一些研究中显示可提高首次穿刺成功率。我们研究了术前超声扫描是否能提高一般成年人群的首次穿刺成功率并缩短操作时间。在这项前瞻性随机对照试验中，招募了170例年龄在21至80岁之间的美国麻醉医师协会1至3级患者。获得了知情同意。患者被随机分为两组，即超声引导下识别标志组（超声组）和手动触诊标志组（手动触诊组）。主要结局是首次穿刺成功率，次要结局是操作所需时间、针头重新定位次数、患者满意度和并发症。超声组的首次穿刺成功率为64%，手动触诊组为52%（P = 0.16）。与手动触诊组相比，超声组的操作时间更短（2.9±3.6分钟对3.9±3.7分钟，P = 0.007）。超声组的患者满意度更高。并发症方面无差异。由于两组之间首次穿刺成功率无统计学显著差异，因此目前关于对所有患者进行常规术前扫描的现有证据不足。目前术前超声扫描的应用可能仅限于采用传统方法进行脊髓麻醉在技术上可能具有挑战性的特定患者。
