The Ultrasound Guided Versus Land-mark Location Method for Performing Spinal Anesthesia in Obese Parturients
Condition: Morbid Obesity
MeSH terms: Obesity, Morbid
Study type: Interventional

Summary: 
      This study will be investigated whether an ultrasound-assisted technique is better than a
      classical land-mark technique to facilitate spinal anesthesia in the lateral position in
      morbidly obese pregnant women with BMI ≥ 40 who will undergo elective cesarean section.

      The primary objective in this study is the rate of successful dural puncture at the first
      attempt. It was assumed that ultrasound could facilitate neuraxial blockade in grade 3
      morbidly obese pregnant women according to the Who classification, whose topographic anatomy
      is difficult.
    

Detailed description: 
      Spinal anesthesia is the most commonly used anesthesia method for elective cesarean
      deliveries. Anesthesiologists may have difficulties in determining the poorly palpable
      surface landmarks in morbidly obese pregnant women.

      Manual palpation technique, which is preferred in neuraxial anesthesia, may be difficult in
      obese pregnant women due to the difficulty in identifying bone landmarks. Neuraxial
      ultrasound examination before spinal anesthesia may help spinal anesthesia performance and
      decrease number of attempts in obese parturients.

      This study will be conducted as a single-center, prospective, randomized, double-blinded
      trial in a university hospital. Patients scheduled for elective cesarean will be screened for
      enrollment in the study. Patient, the anesthetist administering spinal anesthesia and
      evaluating the data were blind to the distribution of patient groups.Ultrasonographic
      examinations were performed by a single investigator trained in this technique who performed
      more than 150 ultrasound-guided neuraxial blocks.
    

Intervention name(s): Ultrasound group; Landmark group
Intervention type(s): Procedure; Procedure
Intervention description(s): In the operating room, all of the patients will receive standard monitoring. Scans will be made in logiditunal parasagittal and transverse midline views with ultrasound. Needle entry sites in the L2-L3 and L3-L4 intervals will be determined as the intersection of the longiditunal and transverse lines.
When the spinal puncture operator is outside the room, Needle entry sites were marked for both groups.After skin marking, the pregnant woman will be asked to remain still and a subarachnoid puncture will be performed immediately. Spinal anesthesia will be administered with injection of intrathecal bupivacaine.; In the Landmark group, the injection site will be determined using the traditional method of palpating the posterior superior iliac spine.When the spinal puncture operator is outside the room, Needle entry sites were marked for both groups.After skin marking, the pregnant woman will be asked to remain still and a subarachnoid puncture will be performed immediately. Spinal anesthesia will be administered with injection of intrathecal bupivacaine.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Parallel Assignment Allocation: Randomized Intervention Model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Spinal Anesthesia; Cesarean Delivery; Ultrasound