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Pre-Procedural Ultrasound Does Not Decrease the Number of Attempts in Trainees Performing Spinal Anesthesia for Obstetric Patients: A RCT
Abstract Number: F 28
Abstract Type: Original Research
Ultrasound guidance has become a standard of care in anesthesia practice. The educational benefits of ultrasound imaging for teaching regional anesthesia have been validated by various studies. For anesthesiology trainees pre procedure spine ultrasound has been shown to reduce the number of attempts and the number of failures in placing epidural catheters. This study was designed to evaluate the benefits of pre- procedural spinal ultrasound guidance on trainee anesthesiologists performing obstetric spinal anesthesia for cesarean section.
In this randomized controlled trial eighty obstetric patients who required elective Cesarean Section were randomized to pre-procedure ultrasound examination and palpation or palpation alone, prior to spinal anesthesia placed by first year anesthesia residents. The primary outcome was the number of attempts for dural puncture. Secondary outcomes included, time to CSF, block location, block height, the need for staff intervention, paresthesia, and bloody tap.. As well, subjective ease of placement was rated by the trainee on a 100 mm visual analog scale.
Results: Baseline demographic data were similar between the two patient groups. The median number of attempts with pre-procedure ultrasound was 3 [interquartile range 2-7]. This was not significantly different from the number of attempts with palpation alone of 3 [1-6], (p = 0.69). The median duration of spinal placement with ultrasound was 92 [51-140] seconds vs. 75 [53-126] seconds with palpation alone (p = 0.56). There was no statistical difference between placement duration, need for staff intervention, paresthesia, bloody tap, block location, block height, or subjective ease of spinal placement.
Conclusion: Pre-procedure spinal ultrasound prior to spinal anesthesia placement by first year anesthesia residents showed no significant difference in the number of attempts, duration of spinal placement, need for staff intervention, paresthesia, presence of blood, block height, or subjective ease of spinal placement.
Orebaugh SL, Williams BA, Kentor ML. Ultrasound guidance with nerve stimulation reduces the time necessary for resident peripheral nerve blockade. Reg Anesth Pain Med 2007 Sep;32(5):448-54.
Vallejo MC, Phelps AL, Singh S, Orebaugh SL, Sah N. Ultrasound decreases the failed labor epidural rate in resident trainees. Int J Obstet Anesth 2010 Aug 7.