RecruitingNot ApplicableNCT06740994

Ultrasound Guided Midline vs Landmark Paramedian Continous Spinal Anesthesia in the Elderly

Ultrasound Guided Midline Continuous Spinal Anesthesia in the Elderly : is There an Advantage Over Conventional Landmark Paramedian Technique: a Randomized Controlled Trial

Sponsor

University Tunis El Manar

Enrollment

110 participants

Start Date

Apr 29, 2024

Study Type

INTERVENTIONAL

Conditions

Spinal Anesthesia

Summary

Former clinical studies have reported the superiority of the landmark guided paramedian approach above the classical landmark guided midline approach for the continuous spinal anesthesia especially in the elderly. On the other hand, more recent clinical trials have suggested that the use of ultrasound to guide spinal anesthesia will be safer and more effective than the conventional palpation-guided technique. The aim of this study will be to compare the conventional "blind" landmark paramedian approach to the ultrasound "modern" guided midline approach for the continuous spinal anesthesia in the elderly with hip fractures. Patients will randomly divided into two groups: Group(PML): will undergo conventional landmark guided paramedian continuous spinal anesthesia Group (MUS): will undergo ultrasound guided midline continuous spinal anesthesia

Eligibility

Min Age: 65 Years

Inclusion Criteria1

all consented patients aged over 65 years old scheduled to undergo surgery for hip fracture under continuous spinal anesthesia with American Society of Anesthesiologists ASA physical status classification from I to III

Exclusion Criteria3

contraindications to spinal anesthesia ( allergy to local anesthetic, coagulopathy, infection at the site of injection)
previous history of lumbar spine surgery
per operative severe complication with conversion to general anesthesia

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Interventions

PROCEDUREconventional landmark paramedian technique

a blind landmark scanning will be done and skin marking of the best palpable spinous process will be made. the site of injection will be determined by palpation. continuous spinal anesthesia will be performed via paramedian approach.

PROCEDUREpreprocedural ultrasound guided midline technique

a preprocedural ultrasound scanning will be done, and skin marking of the best quality space will be made. the site of injection and the insertion angle of the needle will be determined by ultrasound. continuous spinal anesthesia will be performed via midline approach.