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Abstract
Introduction Ultrasonography may facilitate neuraxial blocks in obstetrics. This randomized controlled trial aimed to compare preprocedural ultrasonography with landmark palpation for spinal anesthesia in obese parturients undergoing cesarean delivery.
Methods 280 American Society of Anesthesiologists (ASA) physical status II–III parturients with body mass index ≥35 kg/m2, full-term singleton pregnancy, undergoing elective cesarean delivery under spinal anesthesia, were randomly assigned to two equal groups (ultrasonography and palpation); preprocedural systematic ultrasound approach and conventional landmark palpation were performed, respectively. Patients and outcome assessors were blinded to the study group. All ultrasound and spinal anesthetic procedures were performed by a single experienced anesthesiologist. The primary outcome was the number of needle passes required to obtain free cerebrospinal fluid (CSF) flow. Secondary outcomes were the number of skin punctures required to obtain free CSF flow, success rate at the first needle pass, success rate at the first skin puncture, duration of the spinal procedure, patient satisfaction and incidence of vascular puncture, paresthesia, failure to obtain CSF flow and failed spinal block.
Results There were no significant differences in primary or secondary outcomes between the two groups. The median (IQR) of the number of needle passes required to obtain free CSF flow was 3 (1–7) in ultrasonography group and 3 (1–7) in palpation group; p=0.62.
Conclusions Preprocedural ultrasonography did not decrease the number of needle passes required to obtain free CSF flow or improve other outcomes compared with landmark palpation during spinal anesthesia performed by a single experienced anesthesiologist in obese parturients undergoing cesarean delivery.
- Ultrasonography
- Obstetrics
- REGIONAL ANESTHESIA
Data availability statement
Data are available upon reasonable request. Deidentified patient data are available from the corresponding author upon request by an affiliated researcher interested in this specific topic.
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Data availability statement
Data are available upon reasonable request. Deidentified patient data are available from the corresponding author upon request by an affiliated researcher interested in this specific topic.
Footnotes
Contributors MMT: helped to design the study, conduct the study, analyze the data and prepare the manuscript. He is responsible for the overall content as guarantor. MAT: helped to design the study, conduct the study and prepare the manuscript. MMM: helped to conduct the study and prepare the manuscript. OMI: helped to conduct the study and prepare the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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