ABSTRACT
BACKGROUND: Ultrasound may be useful to identify the spinal anesthesia insertion point, particularly when landmarks are not palpable. We tested the hypothesis that the number of needle redirections/re-insertions is lower when using a handheld ultrasound device compared with palpation in obese women undergoing spinal anesthesia for cesarean delivery. METHODS: Study recruits were obese (body mass index (BMI) >30â¯kg/m2) women with impalpable bony landmarks who were undergoing spinal anesthesia for elective cesarean delivery. Women were randomized to ultrasound or palpation. The primary study outcome was a composite between-group comparison of total number of needle redirections (any withdrawal and re-advancement of the needle and/or introducer within the intervertebral space) or re-insertions (any new skin puncture in the same or different intervertebral space) per patient. Secondary outcomes included insertion site identification time and patient verbal numerical pain score (0-10) for comfort during surgical skin incision. RESULTS: Forty women completed the study. The mean BMI (standard deviation) for the ultrasound group was 39.8 (5.5) kg/m2 and for the palpation group 37.3 (5.2) kg/m2. There was no difference in the composite primary outcome (median (interquartile range) [range]) between the ultrasound group (4 (2-13) [2-22]) and the palpation group (6 (4-10) [1-17]) (P=0.22), with the 95% confidence interval of the difference 2 (-1.7 to 5.7). There were no differences in the secondary outcomes. CONCLUSIONS: Handheld ultrasound did not demonstrate any advantages over traditional palpation techniques for spinal anesthesia in an obese population undergoing cesarean delivery, although the study was underpowered to show a difference.
Subject(s)
Anesthesia, Spinal , Anesthesia, Spinal/methods , Cesarean Section/methods , Female , Humans , Obesity/complications , Palpation/methods , Pregnancy , Ultrasonography, Interventional/methodsABSTRACT
BACKGROUND: We investigated the correlation between lumbar epidural analgesia onset time and pain intensity at 60 and 120â¯min after initiation. METHODS: We conducted a prospective observational study of nulliparous women receiving lumbar epidural analgesia (initial bolus 15â¯mL bupivacaine 0.1% with fentanyl 3.33⯵g/mL), followed by patient-controlled epidural analgesia (PCEA). The measured variable was lumbar epidural analgesia onset time (time to pain numerical rating score ≤3). Secondary outcomes were pain score at 60 and 120â¯min and at full dilatation; and analgesic requirements through the labor. RESULTS: One-hundred-and-five women were eligible for analysis. There was a significant correlation between lumbar epidural analgesia onset time and pain intensity at 60â¯min (Spearman's R2=0.286, P=0.003), but not at 120â¯min (R2=0.030, P=0.76). Women who requested more PCEA boluses during the first 120â¯min had a longer lumbar epidural analgesia onset time (R2=0.321, P=0.001) and reported higher pain scores at 60â¯min (R2=0.588, Pâ¯<0.001) and at 120â¯min (R2=0.539, Pâ¯<0.001). Women who reported higher pain scores at 60â¯min had more pain at 120â¯min (R2=0.47, Pâ¯<0.001) and higher analgesic consumption during labor (R2=0.403, Pâ¯<0.001). Women who were at a greater cervical dilatation at 60 and 120â¯min had higher pain scores at the same time point (R2=0.259, P=0.008 and R2=0.243, P=0.013 respectively). CONCLUSION: There was a correlation between the onset time of lumbar epidural analgesia during labor and the pain score 60â¯min later but this had disappeared by 120â¯min.