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.
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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.
