Comparison between ultrasound-assisted and landmark-guided paramedian spinal anesthesia for hip fracture surgery in the elderly
10.3760/cma.j.issn.0254-9026.2022.11.016
- VernacularTitle:超声辅助定位与体表标记定位旁正中入路腰麻在老年人髋部骨折手术中的应用
- Author:
Hongye ZHANG
1
;
Zongyang QU
;
Yongsheng MIAO
;
Feng LI
Author Information
1. 北京医院麻醉科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Keywords:
Hip fractures;
Sonication;
Intravertebral anesthesia
- From:
Chinese Journal of Geriatrics
2022;41(11):1353-1358
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficiency of the ultrasonic-assisted positioning technique for lumbar anesthesia in elderly patients with hip fractures through the paramedian approach compared with body surface labeling.Methods:Patients(aged ≥65 years)with hip fractures were randomized(1∶1)to receive either ultrasound-assisted or landmark-guided paramedian spinal anesthesia in a lateral position.The primary outcome was the number of needle passes needed for a successful dural puncture.The secondary outcomes included one-pass success rate, number of needle attempts, one-attempt success rate, total time of spinal anesthesia and adverse effects.Results:A total of 88 subjects were randomized.The ultrasound-assisted approach significantly reduced the number of needle passes, compared with the landmark-guided approach[2.0(1.0-3.0) vs.5.0(3.0-8.8); Z=-4.708, P<0.001]. The one-pass success rate was higher in the ultrasound-assisted approach than in the landmark-guided approach[40.9%(18/44) vs.4.5%(2/44); χ2=16.565, P<0.001]. There was no statistical difference in the number of needle attempts and one-attempt success rate between the two groups( P>0.05 for both). The total time of spinal anesthesia was longer in the ultrasound-assisted group than in the landmark-guided group[252(218-317) s vs.168(143-195) s; Z=-5.592, P<0.001]. In the ultrasound-assisted group, fewer patients developed bloody cerebral spinal fluid taps than in the landmark-guided group[0%(0/44) vs.18.2%(8/44); χ2=6.738, P=0.009]. Conclusions:In elderly hip fracture patients, ultrasound-assisted paramedian spinal anesthesia is superior to the landmark-guided approach in reducing the number of needle passes and should be recommended for these patients.
