Ultrasound-guided intrathecal anesthesia: Does scanning help?

Abstract Intrathecal anesthesia is widely used for many surgical procedures. Multiple attempts at needle placement may cause various complications and patient dissatisfaction. Aim To use a preprocedure ultrasound-guided surface marking, using a midline transverse interlaminar ultrasound view at L4–5 interspace, to guide needle insertion, aiming to decrease needle attempts. Subjects and methods Ninety patients ASA I–II, scheduled for intrathecal anesthesia, were included in the study. Patients were randomly allocated to one of 2 groups. Group I was the ultrasound group and Group II was the surface landmark group. For each block, we recorded patient’s and spine characteristics, number of needle attempts, and patient satisfaction, time for establishing landmarks by preprocedure ultrasound scanning or palpation, time to perform spinal anesthesia, and total time to perform the whole procedure. Results Successful first needle attempt was in (80%) in ultrasound group (I) and 17 (37.8%) in surface landmark group (II). Needle redirection attempts were 7 (15.6%) in group I and 16 (35.5%) in group II. Second attempt was in 2 (4.4%) in group I and 5 (11.1%) in group II. Third attempt was observed only in group II in 7 (15.6%). There was a significantly more time needed to establish landmarks and complete spinal anesthesia in group I compared to group II (8.7 ± 1.0 vs 5.4 ± 0.4, respectively). Patient’s satisfaction was significantly higher in group I (95.6%) than group II (77.8%). Conclusion Preprocedure ultrasound scanning improved the first needle attempt success rate, decreased redirection or further attempts, and gave better patient satisfaction.