Impact of ultrasound on the performance of spinal anesthesia

Position du problème et objectif(s) de l’étude

Neuraxial anesthesia is a commonly employed technique for subumbilical surgical procedures due to its effectiveness and safety profile. The advent of ultrasound technology has introduced the possibility of visualizing anatomical landmarks in real time, thereby facilitating more accurate and potentially safer subarachnoid punctures. This study aims to compare conventional spinal anesthesia, based on palpation, with ultrasound-guided spinal anesthesia, focusing on procedural ease and overall facilitation.

Matériel et méthodes

We conducted a prospective, single-center, randomized, single-blind study. We included patients aged 18 years or older, classified as ASA I or II, scheduled for elective surgery, and who provided written informed consent. Exclusion criteria included failed subarachnoid puncture, conversion to general anesthesia, or the occurrence of major intraoperative complications such as vasovagal episodes or cardiac rhythm disturbances. Participants were randomly assigned, based on a randomization table, into two groups: Group GT (traditional technique), in which spinal anesthesia was performed using the conventional palpation-based method for space localization; and Group GE (ultrasound-guided technique), in which spinal anesthesia was performed under real-time ultrasound guidance. The primary outcome was the total procedure time, measured in seconds from the end of skin antisepsis to the initiation of subarachnoid injection. Secondary outcomes included the number of puncture attempts, the number of needle redirections within the same interspace, the occurrence of procedural incidents, and postoperative complaints such as radicular pain, osseous contact pain, intraoperative paresthesias, and traumatic punctures.

Résultats & Discussion

A total of 135 patients were included in the final analysis. The mean age was 62 ± 16 years, with a male predominance (male-to-female ratio: 1.45). The two groups were comparable in terms of demographic characteristics and medical history. There was no statistically significant difference in the overall duration of the spinal anesthesia procedure between the two groups: 126.3 seconds [78–168.4] in the traditional group (GT) versus 131.9 seconds [103–163.2] in the ultrasound-guided group (GE), with a p-value of 0.103. Similarly, the number of needle redirections within the same interspace did not differ significantly between groups (p = 0.122). However, the number of puncture attempts was significantly lower in the ultrasound-guided group (p < 0.001). A subgroup analysis revealed that in patients with a history of spinal surgery, the procedure duration was significantly longer in the traditional technique group compared to the ultrasound-guided group (204 ± 78.7 seconds vs. 153.5 ± 24.8 seconds, p = 0.027). In contrast, when the spinous processes were not palpable, there was no significant difference in procedure time between the two groups (p = 0.282). In terms of intraoperative incidents, traumatic punctures were significantly more frequent in the traditional group compared to the ultrasound-guided group (17.6% vs. 1.5%, p = 0.002).

Conclusion

Ultrasound-guided spinal anesthesia significantly reduces the number of puncture attempts and the incidence of traumatic punctures, especially in patients with challenging anatomy or prior spinal surgery. Although the technique tends to prolong the procedure time, the difference is not statistically significant in most cases.

Auteurs

Haythem ELASKRI, Ahlem BATIKH, Sirine CHILLI, Farah GUITOUNI, Eya BEN AMRI, Imen NAAS, Iheb LABBENE - (1)Hôpital Militaire, Tunis, Tunisie

Orateur(s)

Haythem ELASKRI (Tunis)