To compare the effectiveness of real-time ultrasound guided spinal anaesthesia versus pre procedural ultrasound guided spinal anaesthesia in obese parturients: a randomized control trial

Abstract

BACKGROUND: Spinal anesthesia is the preferred technique for elective cesarean sections. However, standard landmark-guided approaches can be challenging in obese parturients due to difficulty in identifying anatomical landmarks, leading to multiple attempts and increased complication risks. Neuraxial ultrasound-guided (USG) techniques offer a promising solution by enhancing procedural accuracy and efficiency. AIM: The Aim of our study is to compare the effectiveness of real-time ultrasound-guided (RUS) spinal anesthesia versus pre-procedural ultrasound-guided (PPUS) spinal anesthesia in obese parturients posted for elective cesarean sections. METHODOLOGY: A total of 80 obese parturients (BMI >30 kg/m2, ASA II-III) who were scheduled for elective cesarean sections were randomized into two groups: Group PPUS and Group RUS. Primary outcomes included the number of attempts, needle passes, and time taken for successful dural puncture. Secondary outcomes included intervertebral space identification time, successful analgesia time, and hemodynamic stability. Statistical analysis was performed using SPSS v20, with p<0.05 considered significant. 10 Docusign Envelope ID: EC662210-CC2F-4FA0-832C-C62D38F6813A RESULTS : The Group RUS demonstrated significantly fewer attempts (1.7±0.6 vs. 4.5±1.0, p<0.05) and needle passes (2.1±1.0 vs. 5.7±1.3, p<0.05) compared to the Group PPUS . The mean time for intervertebral space identification was shorter in the Group RUS (60.3±25.6 vs. 160.8±45.2 seconds, p<0.05), as was the time for successful lumbar puncture (93.6±30.0 vs. 249.2±63.3 seconds, p<0.05). Both groups achieved a 100% success rate in spinal anesthesia. CONCLUSION : Both Group RUS and Group PPUS techniques are effective for spinal anesthesia in obese parturients. However, RUS was significantly betteri technique in reducing the number of attempts, needle passes, and procedural time, making it a more efficient and precise.