Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: Is this better than landmark-guided midline approach? A randomised controlled trial

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dc.contributor.author Srinivasan, Karthikeyan
dc.contributor.author Leo, Anne-Marie
dc.contributor.author Iohom, Gabriella
dc.contributor.author Loughnane, Frank
dc.contributor.author Lee, Peter
dc.date.accessioned 2018-01-22T16:33:52Z
dc.date.available 2018-01-22T16:33:52Z
dc.date.issued 2018-01-12
dc.identifier.citation Srinivasan, K., Leo, A.-M., Iohom, G., Loughnane, F. and Lee, P. (2018) 'Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: Is this better than landmark-guided midline approach? A randomised controlled trial', Indian Journal of Anaesthesia, 62(1), pp. 53-60. doi: 10.4103/ija.IJA_448_17 en
dc.identifier.volume 62 en
dc.identifier.issued 1 en
dc.identifier.startpage 53 en
dc.identifier.endpage 60 en
dc.identifier.issn 0019-5049
dc.identifier.uri http://hdl.handle.net/10468/5312
dc.identifier.doi 10.4103/ija.IJA_448_17
dc.description.abstract Background and Aims: Routine use of pre-procedural ultrasound guided midline approach has not shown to improve success rate in administering subarachnoid block. The study hypothesis was that the routine use of pre-procedural (not real time) ultrasound-guided paramedian spinals at L5-S1 interspace could reduce the number of passes (i.e., withdrawal and redirection of spinal needle without exiting the skin) required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach. Methods: After local ethics approval, 120 consenting patients scheduled for elective total joint replacements (Hip and Knee) were randomised into either Group C where conventional midline approach with palpated landmarks was used or Group P where pre-procedural ultrasound was used to perform subarachnoid block by paramedian approach at L5-S1 interspace (real time ultrasound guidance was not used). Results: There was no difference in primary outcome (difference in number of passes) between the two groups. Similarly there was no difference in the number of attempts (i.e., the number of times the spinal needle was withdrawn from the skin and reinserted). The first pass success rates (1 attempt and 1 pass) was significantly greater in Group C compared to Group P [43% vs. 22%, P = 0.02]. Conclusion: Routine use of paramedian spinal anaesthesia at L5-S1 interspace, guided by pre-procedure ultrasound, in patients undergoing lower limb joint arthroplasties did not reduce the number of passes or attempts needed to achieve successful dural puncture. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Wolters Kluwer - Medknow en
dc.rights © 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer – Medknow. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. en
dc.rights.uri https://creativecommons.org/licenses/by-nc-sa/3.0/
dc.subject Paramedian en
dc.subject Spinal anaesthesia en
dc.subject Ultrasound en
dc.title Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: Is this better than landmark-guided midline approach? A randomised controlled trial en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Gabriella Iohom, Surgery, University College Cork, Cork, Ireland. +353-21-490-3000 Email: giohom@ucc.ie en
dc.internal.availability Full text available en
dc.date.updated 2018-01-22T16:29:45Z
dc.description.version Published Version en
dc.internal.rssid 422811073
dc.description.status Peer reviewed en
dc.identifier.journaltitle Indian journal of anaesthesia en
dc.internal.copyrightchecked No !!CORA!! en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress giohom@ucc.ie en


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© 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer – Medknow. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. Except where otherwise noted, this item's license is described as © 2018 Indian Journal of Anaesthesia | Published by Wolters Kluwer – Medknow. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
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