Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures : a randomized controlled trial
BACKGROUND: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures.
METHODS: This prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.
RESULTS: Eighty patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20 and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5 and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1 [1]) than landmark-guided group (2 [1, 2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1 [1, 2]) than in landmark-guided group (3 [2, 4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4-5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.
CONCLUSIONS: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.
TRIAL REGISTRATION: Chinese Clinical Trial Register (identifier, ChiCTR1900020819 ; date of registration, January 20, 2019).
| Errataetall: |
ErratumIn: BMC Anesthesiol. 2020 Oct 23;20(1):268. - PMID 33096999 |
|---|---|
| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:20 |
|---|---|
| Enthalten in: |
BMC anesthesiology - 20(2020), 1 vom: 28. Sept., Seite 248 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Qu, Bo [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Aged |
|---|
| Anmerkungen: |
Date Completed 02.09.2021 Date Revised 02.09.2021 published: Electronic ErratumIn: BMC Anesthesiol. 2020 Oct 23;20(1):268. - PMID 33096999 Citation Status MEDLINE |
|---|
| doi: |
10.1186/s12871-020-01172-x |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM315590521 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM315590521 | ||
| 003 | DE-627 | ||
| 005 | 20231225155236.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1186/s12871-020-01172-x |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1051.xml |
| 035 | |a (DE-627)NLM315590521 | ||
| 035 | |a (NLM)32988366 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Qu, Bo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures |b a randomized controlled trial |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 02.09.2021 | ||
| 500 | |a Date Revised 02.09.2021 | ||
| 500 | |a published: Electronic | ||
| 500 | |a ErratumIn: BMC Anesthesiol. 2020 Oct 23;20(1):268. - PMID 33096999 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures | ||
| 520 | |a METHODS: This prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation | ||
| 520 | |a RESULTS: Eighty patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20 and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5 and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1 [1]) than landmark-guided group (2 [1, 2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1 [1, 2]) than in landmark-guided group (3 [2, 4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4-5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis | ||
| 520 | |a CONCLUSIONS: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice | ||
| 520 | |a TRIAL REGISTRATION: Chinese Clinical Trial Register (identifier, ChiCTR1900020819 ; date of registration, January 20, 2019) | ||
| 650 | 4 | |a Comparative Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Combined spinal-epidural anesthesia | |
| 650 | 4 | |a Hip fractures | |
| 650 | 4 | |a Ultrasonography | |
| 700 | 1 | |a Chen, Luying |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Yuling |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Mengting |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Caineng |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Wuhua |e verfasserin |4 aut | |
| 700 | 1 | |a Li, Yuhui |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t BMC anesthesiology |d 2001 |g 20(2020), 1 vom: 28. Sept., Seite 248 |w (DE-627)NLM116144939 |x 1471-2253 |7 nnns |
| 773 | 1 | 8 | |g volume:20 |g year:2020 |g number:1 |g day:28 |g month:09 |g pages:248 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1186/s12871-020-01172-x |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 20 |j 2020 |e 1 |b 28 |c 09 |h 248 | ||