Real Time Ultrasound Guided Spinal Anesthesia in Elderly Patients: Paramedian Transverse Versus Parasagittal Oblique Approach

Study Overview
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Brief Summary
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In this prospective randomized observational study, we aim to compare real time ultrasound-guided paramedian technique using parasagittal oblique view with real time ultrasound-guided paramedian technique using the paramedian transverse median view. Our aim is to find the most suitable real time ultrasound guided approach with regard to ease of performance defined as success rate at first attempt, number of puncture attempts, spinal procedure time, and patient satisfaction.

Official Title
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Real Time Ultrasound Guided Spinal Anesthesia in Elderly Patients: Paramedian Transverse Versus Parasagittal Oblique Approach

Conditions
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Realtime Ultrasound

Intervention / Treatment
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* Device: Parasagittal oblique technique (Ultrasound)
* Device: Paramedian tranverse technique (Ultrasound)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients aged more than 65 years American Society of Anesthesiologists physical status 1 to 3 Can give informed consent scheduled for surgery amenable to spinal anesthesia Exclusion Criteria: Inability to give consent Patient refusal Contraindications to spinal anesthesia including coagulopathy INR>1.5 Platelet count< 75 × 109/L Indeterminate neurologic disease Local infection at the site of injection Allergy to local anesthetics Patients with back deformities (scoliosis, kyphosis, and with prior operations in the same area of the surgery)

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Real time ultrasound-guided Parasagittal oblique technique<br> | Device: Parasagittal oblique technique (Ultrasound)<br>* the probe will be placed in a parasagittal plane to identify the articular processes then the sacrum will be identified. The probe will be moved cephalad in the parasagittal axis until the identification of the target lumbar interspaces L2-L3, L3-L4 or L4-L5. Once the appropriate lumbar interspace is identified, the probe will be tilted 45 degree towards the midline into a parasagittal oblique view. The needle will be inserted in plane from the caudal end of the ultrasound transducer with its tip directed towards the interlaminar space under real-time in-plane US guidance.<br>|
| Experimental: Real time ultrasound-guided paramedian tranverse technique<br> | Device: Paramedian tranverse technique (Ultrasound)<br>* the transducer will be applied in the parasagittal plane, and after identification of the intervertebral level, the probe will be rotated 90 degrees into a transverse orientation and centered on the neuraxial midline in a way to align the beam with the interspinous and interlaminar space and thus to get a paramedian transverse interlaminar view. The needle will be inserted in plane from the lateral end of the ultrasound transducer with its tip directed towards the medial border of the articular process.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Rate of successful Dural puncture on the first needle insertion attempt | Successful needle insertion on the first attempt | At the begining of the procedure (during the needle insertion) |