Comparison Of Ultrasound Versus Landmark Guided Insertion Of Combined Spinal Epidural In Total Hip Replacement/Total Knee Replacement Surgeries

Background: Multiple attempts and needle redirection in a single attempt while performing combined spinal epidural anaesthesia are associated with a greater incidence of postdural puncture headache, paraesthesia, and spinal hematoma. We hypothesized that the routine use of a preprocedural ultrasound-guided combined spinal epidural anaesthesia would reduce the number of attempts and needle redirection in a single attempt when compared with the conventional landmark-guided combined spinal epidural anaesthesia. Methods: Sixty consenting patients scheduled for elective total joint replacements (hip and knee) were randomized into group U (Ultrasound guided technique) and group L (Landmark technique) with 30 in each group. In group L, combined spinal epidural was done via the midline approach using clinically palpated landmarks. In group U, a preprocedural ultrasound scan was used to mark the insertion site, and combined spinal epidural anaesthesia was performed. Results: The mean number of attempt was lower in Group U (1.06±0.25) than Group L (1.26±0.89) and p-value (0.039) was found to be significant. The mean total number of needle redirection in a single attempt were found to be lower in Group U (1.16±0.53) than Group L (1.60±0.89) and the p-value (0.027) was found to be significant. The mean value of time taken for identifying landmark for Group U (126.9±9.31) was higher than Group L (25±7.08) and p-value (<0.05) was found to be significant.The mean value of time taken for the procedure was higher in Group U (634.83±48.90) than Group L (458.93±41.15) and p-value (<0.05) was found to be significant. The mean periprocedural VAS score of pain and the demographic profile were comparable in both groups. Conclusion: Routine use of combined spinal epidural anaesthesia in the orthopaedic patient population undergoing joint replacement surgery, guided by preprocedural ultrasound examination, significantly decreases the number of attempts and needle redirection needed to enter the subarachnoid and epidural space.