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Ultrasound has emerged as an useful tool for neuraxial blockade. The aim of this study is to compare the efficacy and safety between the midline approach and paramedian approach for ultrasound-assisted spinal anesthesia in adult patients.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Midline group | Experimental | Preprocedural ultrasound-assisted midline approach of spinal anesthesia will be performed. 0.5% heavy bupivacaine will be injected to intrathecal space for spinal anesthesia. |
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| Paramedian group | Active Comparator | Preprocedural ultrasound-assisted paramedian approach of spinal anesthesia will be performed. 0.5% heavy bupivacaine will be injected to intrathecal space for spinal anesthesia. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| ultrasound-assisted midline approach | Procedure | A preprocedural ultrasound scanning will be done, and skin marking will be made. The needle entry point and insertion angle will be determined based on ultrasound scanning. Spinal anesthesia will be performed via midline approach. |
| Measure | Description | Time Frame |
|---|---|---|
| the number of needle passes | the number of forward advancements of the spinal needle in a given interspinous space, i.e., withdrawal and redirection of spinal needle without exiting the skin | Intraoperative (from the first insertion of needle to patient's skin, until the completion of spinal anesthetic injection) |
| Measure | Description | Time Frame |
|---|---|---|
| Number of spinal needle insertion attempts | the number of times the spinal needle was withdrawn from the skin and reinserted | Intraoperative (from the first insertion of needle to patient's skin, until the completion of spinal anesthetic injection) |
| Time for identifying landmarks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jin-Tae Kim, MD, PhD | Seoul National University Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Seoul National University Hospital | Seoul | 03080 | South Korea |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 26270115 | Background | Kallidaikurichi Srinivasan K, Iohom G, Loughnane F, Lee PJ. Conventional Landmark-Guided Midline Versus Preprocedure Ultrasound-Guided Paramedian Techniques in Spinal Anesthesia. Anesth Analg. 2015 Oct;121(4):1089-1096. doi: 10.1213/ANE.0000000000000911. | |
| 35421679 | Derived | Park SK, Cheun H, Kim YW, Bae J, Yoo S, Kim WH, Lim YJ, Kim JT. Ultrasound-assisted spinal anesthesia: A randomized comparison between midline and paramedian approaches. J Clin Anesth. 2022 Sep;80:110823. doi: 10.1016/j.jclinane.2022.110823. Epub 2022 Apr 11. |
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|
| ultrasound-assisted paramedian approach | Procedure | A preprocedural ultrasound scanning will be done, and skin marking will be made. The needle entry point and insertion angle will be determined based on ultrasound scanning. Spinal anesthesia will be performed via paramedian approach. |
|
time from placement of the ultrasound probe on the skin to the completion of markings. |
| intraoperative (time taken for establish the landmark, from start of US scanning to completion of scanning |
| Time taken for performing spinal anesthetic | time from needle insertion to the completion of injection | Intraoperative (from insertion of the needle to the completion of injection) |
| dermatome level of sensory block | thoracic dermatome level of sensory block assessed by loss of cold sensation tested with 2% chlorhexidine swab | 20 minutes after the completion of spinal anesthetic injection |
| Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle | Incidence of radicular pain, paraesthesia, and blood tapping in the spinal needle during the spinal anesthesia procedure | Intraoperative (from the first insertion of needle, until the completion of spinal anesthetic injection) |
| Periprocedural pain | 11-point verbal rating scale (0=no pain, 10=most pain imaginable) | Patients will be asked immediately after the completion of spinal anesthesia |
| Periprocedural discomfort score | 11-point verbal rating scale (0=no discomfort, 10=most discomfort imaginable) | Patients will be asked immediately after the completion of spinal anesthesia |
| Patient satisfaction score of spinal anesthesia procedure | 11-point verbal rating scale (0=very unsatisfied, 10=very satisfied) | Patients will be asked immediately after the completion of spinal anesthesia |