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Evaluation of Success in Neuraxial Block Placement between using Palpation of Landmark versus Pocket-Size Handheld Ultrasound (U/S) Method
Abstract Number: F1B-6
Abstract Type: Original Research
Introduction: Administration of spinal block(SAB) is commonly achieved by palpating surface landmarks. This becomes more challenging in obese patients. Applying conventional U/S for SAB has limitations due to bulkiness, long learning curve and technical difficulties. A newly developed pocket size U/S(Rivanna Accuro) addresses these limitations by providing real time pattern recognition for spinal bony structures and 3D overlay for recognition of spinous process and intervertebral space. We hypothesize this U/S device may reduce time and attempts to successfully place SAB vs conventional palpation (P) in obese patients.
Method: 60 patients with BMI >30, having SAB for C/S were planned for consent and randomized into groups Palpation(P) and U/S(U). In group U, the needle insertion site was identified and marked by U/S(Rivanna Accuro), and was used by a separate experienced provider to perform SAB without palpating landmarks. Group P used usual P to identify needle insertion site. The primary outcome was time from spinal needle insertion to CSF return. Secondary outcomes were: a)# of needle passes, defined as pulling the spinal needle/introducer back to superficial subcut tissue or reinserting at a different level, b)# of redirections, defined as changes in angle without making a new pass and c)# of first attempt successes. U/S and P time, as well as VAS pain score and satisfaction score (0-10) associated with SAB were obtained.
Results: 29 of the 60 planned subjects were enrolled so far. Table 1 shows that the age, gest age, BMI and time to scan vs palp were similar between Group P and U. Median scanning time was 29sec(U) vs 28sec(P), thus U/S scanning did not add time to the total procedure. Our primary outcome, time from spinal needle insertion to CSF return was shorter using the U/S technique, median time 46sec vs 121.5sec in Group P. Group U also showed: a) increased success of single spinal needle passes (29% vs 17%) to obtain CSF, and increasing patient satisfaction scores (10 vs 8.5), while there was (b) reduced median number of spinal needle passes (1 vs 2) and redirections (1 vs 3.5); and reduced patient reported VAS pain scores for the procedure (3 vs 4).
Conclusion: Our preliminary results suggest that the Rivanna Accuro U/S device shortened time for successful insertion of SAB in obese (BMI>30) patients for C/S as compared to using palpation. The final completed study data and statistical comparison of all 60 subjects will be presented at SOAP.