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Spinal anesthesia depends on being able to locate physical landmarks on a patient's body. In obese patients, the commonly used landmarks may be difficult or even impossible to feel. In addition, the spine can be hidden beneath a layer of fatty tissue.
Ultrasound is useful for finding the correct injection site in pregnant patients, but the usefulness of ultrasound has not been adequately evaluated in non-pregnant patients. The potential benefits for obese patients from the use of ultrasound include shortening the duration of the procedure, increasing patient comfort, decreasing the total number of attempts, and aiding in the choice of appropriate needle length for the patient.
The investigators hypothesize that there is no difference in time to perform a spinal anesthetic when landmarking with ultrasound as compared to tactile landmarking in patients with BMI > 35.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Spinal with ultrasound guidance | Experimental | The intervention group's interspaces will be determined using the curved linear probe on a Zonare ultrasound using two views. |
|
| Spinal by palpation of Tuffier's line | Active Comparator | Current clinical practice. Standard of care would have the attending anesthetist palpate the Tuffier's line to pinpoint the appropriate location for the spinal. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasound guidance | Procedure | The intervention group's interspaces will be determined using the curved linear probe on a Zonare ultrasound using two views. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Total time to perform the spinal | From the beginning of palpation or ultrasound to free flow of Cerebral Spinal Fluid (CSF), up to 1 hour. |
| Measure | Description | Time Frame |
|---|---|---|
| Time from administration of the local anesthetic needle until free flow CSF | Up to 1 hour | |
| Number of needle redirections | At time of spinal anesthetic administration | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jacelyn Larson, MD FRCP | University of Saskatchewan | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Saskatoon City Hospital | Saskatoon | Saskatchewan | S7K 0M7 | Canada | ||
| Saint Paul's Hospital |
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| ID | Term |
|---|---|
| D000775 | Anesthesia, Spinal |
| ID | Term |
|---|---|
| D000765 | Anesthesia, Conduction |
| D000758 | Anesthesia |
| D000760 | Anesthesia and Analgesia |
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| Palpation of Tuffier's line | Procedure | Current clinical practice. Standard of care would have the attending anesthetist palpate the Tuffier's line to pinpoint the appropriate location for the spinal. |
|
| Spinal anesthetic | Procedure | Subcutaneous local infiltration with a 25g needle we be performed prior to the spinal. Neuraxial technique will be attempted midline with a 25 gauge whitacre needle in the sitting position. Spinals will be attempted on either L2-L3, L3-L4, L4-L5 interspaces. The amount and type of local anesthetic/intrathecal narcotic will be left to the discretion of the Anesthetist. |
|
| Number of attempts to complete the spinal |
As measured by new needle puncture sites, according to the anesthetist performing the procedure |
| At time of spinal anesthetic administration |
| Number of failed blocks | Defined as unable to get free flow CSF or inadequate surgical block after administration of neuraxial anesthetic after 15 minutes. | Up to 15 minutes after administration of spinal anesthesia |
| Saskatoon |
| Saskatchewan |
| S7M 0Z9 |
| Canada |