Uyel Yasin, Kilicaslan Alper
Department of Anaesthesiology and Reanimation, Necmettin Erbakan University, Meram Medical Faculty, Konya, Turkey.
Eurasian J Med. 2021 Feb;53(1):9-14. doi: 10.5152/eurasianjmed.2020.20215. Epub 2020 Nov 23.
This study was aimed to determine whether preprocedural ultrasonography (USG) affects the technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis, or previous spine surgery.
This prospective study was conducted in 156 elderly patients scheduled for elective orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique (group P). The primary finding of our study was the rate of successful access to the subarachnoid space on initial needle insertion attempt. Secondary achievements included number of needle insertion attempts, number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia.
The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P, 3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among the patients in group P than those in group U. No statistically significant difference was found between the groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced complications (p>0.05).
Our study findings showed that preprocedural neuroaxial USG improves technical performance of spinal anesthesia in elderly patients with difficult anatomy.
本研究旨在确定术前超声检查（USG）是否会影响存在体表标志触诊困难、脊柱侧弯或既往脊柱手术史的老年患者脊髓麻醉的技术操作。
本前瞻性研究纳入了156例计划接受择期骨科下肢手术的老年患者。患者被随机分为两组，分别通过术前USG检查接受脊髓麻醉（U组）或传统体表标志触诊技术（P组）。本研究的主要观察指标是首次进针尝试时成功进入蛛网膜下腔的比例。次要观察指标包括进针尝试次数、进针方向调整次数、总操作时间、进针疼痛评分、患者满意度以及脊髓麻醉的并发症。
U组首次进针尝试时成功进入蛛网膜下腔的比例显著高于P组（74.4%对53.8%，p = 0.008）。为实现硬膜穿刺，P组患者的进针尝试次数（P组，2[1 - 3]对U组，1[1 - 2]；p = 0.038）和进针方向调整次数（P组，3[2 - 5]对U组，2[1 - 4]；p = 0.028）的中位数均显著高于U组患者。两组在总操作时间､疼痛评分､患者满意度评分以及脊髓麻醉引起的并发症方面未发现统计学显著差异（p>0.05）。
我们的研究结果表明，术前神经轴超声检查可改善解剖结构复杂的老年患者脊髓麻醉的技术操作。
