Abstract

Background:Standard technique of performing spinal anaesthesia through lumbar puncture for surgeries involving lower abdomen, perineum and lower extremities has lower yield in patients with obesity, pregnancy etc where there is difficulty to identify the landmarks. Pre-procedural ultrasound guided identification of landmarks can overcome these shortcomings. The objective of this study aimed to compare conventional landmark guided spinal anaesthesia and pre procedure ultrasound guided spinal anaesthesia through midline approach in patients who underwent surgery in lower abdomen and lower extremities and determine which technique is better in reducing number of attempts and passes. Methodology: Prospective randomized control study was conducted between June 2018 to June 2019 on 106 patients. Patients were randomized to two groups of 53 each by computer generated table to receive one of the following for the subarachnoid block: Group A (n=53) was patients underwent conventional landmark technique anaesthesia & Group B (n=53) was patients underwent ultrasound guided anaesthesia through midline approach and the number of attempts and passes were documented for both the groups. All the data were analysed using SPSS v.23.0. Data was presented in the form of percentages, mean and SD. Tests like Chi-square (χ2)/Freeman-HaltonFisher exact test and unpaired t test was applied. A p-value of <0.05 was considered to be significant. Results: In group A, mean number of attempts was 1.36 with standard deviation of 0.48 and mean number of passes was 1.50 with standard deviation of 0.51. In group B, mean number of attempts was 1.34 with standard deviation of 0.48 and mean number of passes was 1.49 with standard deviation of 0.51. This difference was not found to be statistically significant (P value = 0.840 & 0.907 respectively) Conclusion: Study revealed that pre-procedural ultrasound guided identification of landmarks and subsequent administration of spinal anaesthesia was not superior to conventional anatomical landmark identification. Hence medical strategy based on above conclusions needs further investigation.

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