Ultrasound Assisted versus Landmark Guided Spinal Anesthesia in Patients with  Abnormal Spinal Anatomy

Objective: To compare the efficacy of ultrasound assisted versus landmark guided spinal anesthesia in patients with difficult anatomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Anesthesiology, Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Mar 2022. Methodology: We enrolled a total of 70 patients, scheduled for elective lower extremity surgery, under spinal anesthesia for this study. Patients were randomly divided into two groups with the help of random numbers generated using MS Excel. Patients in Group-A, underwent spinal anesthesia using the surface landmark–guided approach (Landmark Group) and in Group-B, patients underwent pre-procedural ultrasound–assisted (Ultrasound Group) technique. Results: Single puncture and single re-direction rate was found to be significantly higher for patients in Group-B and rate of single attempt (1 attempt: Group-A: 13(37.1%) vs. Group-B: 24(68.6%), p-value=0.031) along with number of needle redirections (1-2 attempt: Group-A: 9(25.7%) vs. Group-B: 23(65.7%), p-value=0.009) was also significantly higher for patients in Group-B. No significant difference in complications was seen between groups. However, Group-A encountered higher frequency of complications as compared to Group-B. Conclusion: Pre-procedural ultrasound assisted technique is more effective for successful access to subarachnoid space at the first attempt and reduces the number of needle redirections as compared to landmark-guided technique.