Abstract
BackgroundCombined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. However, it is difficult to perform in obese parturients because of positioning challenges. The aim of this study was to compare the effect of different approaches to CSEA under the guidance of ultrasound.MethodsOne hundred obese patients (BMI ≥ 30 kg/m2) who underwent elective cesarean section were randomly enrolled. Patients were assigned to a median approach group and a paramedian approach group randomly. Clinical characteristics were compared between groups. First-attempt success rate, the median positioning time and total operation time, ultrasonic predicted anesthesia puncture depth, actual puncture depth, anesthesia adverse reactions, complications after anesthesia, and patients’ satisfaction with the epidural puncture were recorded.ResultsThe first-attempt success rate was significantly different between the two groups [92% (46/50) vs. 76% (38/50), P = 0.029]. The median positioning time and total operation time in the paramedian approach group were higher than those in the median approach group (227.7 s vs. 201.6 s, P = 0.037; 251.3 s vs. 247.4 s, P = 0.145). The incidence of postanesthesia complications in the paramedian approach group was significantly lower than that in the median approach group (2% vs. 12%, P = 0.026), and patient satisfaction was higher in the paramedian approach group than in the median approach group (P = 0.032).ConclusionThe ultrasound-guided paramedian approach for CSEA is time-consuming, but it can effectively improve the success rate of the first puncture, reduce the incidence of anesthesia-related adverse reactions, and improve patient satisfaction.Trial registration: This study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024722) on July 24, 2019
Highlights
Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries
This provides some guidance for anesthesiologists for conducting ultrasound-guided epidural puncture
Studies have found that there may be no significant difference in the timing between traditional intraspinal puncture by experienced anesthesiologists and ultrasound-guided epidural puncture [7,8,9], which does not reflect the application advantage of ultrasound in epidural puncture
Summary
Combined spinal epidural anesthesia (CSEA) is commonly performed in cesarean deliveries. Combined spinal epidural anesthesia (CSEA) has the advantages of quick onset, good effect and controllable action time It has been widely used in clinical practice and became the preferred anesthesia method for. Some studies have shown that there was a certain difference between the ultrasonic prediction of puncture depth and the actual operation of epidural puncture depth, there is still a good correlation between them [5] This provides some guidance for anesthesiologists for conducting ultrasound-guided epidural puncture. The first puncture success rate in the ultrasound group was significantly improved, the number of punctures was significantly reduced, the incidence of postoperative low back pain of parturients was reduced, and the safety of anesthesia was increased These findings are consistent with the conclusions of other researchers [11]
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