Ultrasound Guided Spinal Anesthesia in Non Obese Obstetric Patients

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01440400
Recruitment Status : Completed
First Posted : September 26, 2011
Last Update Posted : March 12, 2013
Information provided by (Responsible Party):
Dr. Tarek Ansari, Corniche Hospital

Brief Summary:

The classical method for spinal anesthesia relies on the use of bony landmarks to identify the level and point of entry of the spinal needle. Over the years, in experienced hands, this method consistently proved to be successful and safe.

The introduction of ultrasound to guide neuraxial anaesthesia into clinical practice was relatively slow compared to peripheral nerve blocks or central venous catheterization. This could be due to the technical difficulties posed by the bony structures surrounding the spinal cord and its dura that blocks the path of the ultrasound beam. Many anesthetists are reluctant to change their conventional landmark technique, particularly with most studies showing no change in the success rate between ultrasound guided and the landmark techniques.

Several studies however showed that the ultrasound guided approach reduces the number of attempts to achieve a successful block and reduces the procedure time particularly in obese patients and those with technical difficulties.

In this study the investigators are trying to answer the following question : Is there any advantage in using ultrasound to guide spinal anaesthesia in non obese obstetric patients with easily palpable bony landmarks?

Condition or disease Intervention/treatment Phase
Cesarean Section Procedure: Ultrasound guided spinal anesthesia Not Applicable

Detailed Description:

Patients will be randomized using a web based randomization program into two groups: Ultrasound guided spinal anesthesia (US) & conventional spinal anesthesia (C). In both groups, the level of the third or fourth lumbar inter-space (L3/4 or L4/5) will be identified using either ultrasound (transverse and longitudinal approach) or palpation method using anatomical landmarks.

All ultrasound examinations and spinal anesthesia will be performed by 3 anesthetists with experience in ultrasound guided neuraxial block (between 100 and 200 cases). The ultrasound examination will be done using Logiq e TM ultrasound machine (GE Solingen Germany) with 4C RS 2 - 5.5MHz Broadband multi-frequency probe.

The predetermined point of entry for the introducer needle will be marked on the patient's back. The spinal anaesthesia will be administered with the patient in the sitting position, using a 26 gauge pencil point needle (PortexTM) with 15 mg of heavy Bupivacaine and 20 micrograms of Fentanyl. An independent observer, who is blinded to the method used to identify the point of entry of the introducer needle, will be collecting the data.The spinal anesthesia will be labeled as successful if a bilateral block to the sixth thoracic dermatome (T6) , judged by loss of cold and touch discrimination, is established 5 minutes after the spinal injection.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 150 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Official Title: The Use of Ultrasound to Guide Spinal Anesthesia in Obstetrics. Is There an Advantage Over Landmark Technique in Non-obese Patients?
Study Start Date : October 2011
Actual Primary Completion Date : July 2012
Actual Study Completion Date : October 2012

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
No Intervention: Conventional spinal anesthesia
Experimental: Ultrasound guided spinal anesthesia Procedure: Ultrasound guided spinal anesthesia
Using the ultrasound to identify the spinal puncture level, mid-line and the depth of the dura.

Primary Outcome Measures :
  1. The number of skin punctures [ Time Frame: 30 minutes ]
    Number of times the skin is punctured by the introducer needle.

  2. The number of spinal needle passes [ Time Frame: 30 minutes ]
    The number of times the spinal needle tip is advanced beyond the tip of the introducer needle.

  3. The time of the procedure [ Time Frame: 30 minutes ]
    From skin puncture by the introducer to viewing cerebro-spinal fluid back-flow at the hub of the spinal needle.

Secondary Outcome Measures :
  1. The patient satisfaction with spinal anesthesia [ Time Frame: 24 hours ]
    scale 0-10, 0=not satisfied, 10=completely satisfied

  2. Backache after spinal needle placement, assessed within 24 hours postoperatively [ Time Frame: 24 hours ]
    verbal rating scale(VRS), 0-10, 0=no pain, 10=maximum pain.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • All mothers with body mass index (BMI) equal to or less than 35 who has normal singleton pregnancy
  • At 37 weeks gestation or more
  • Admitted to Corniche Hospital for elective caesarean section under spinal anaesthesia

Exclusion Criteria:

  • Patients with BMI >35
  • Patieints with difficult anatomical landmarks
  • Patients with neurological disease or coagulation defects
  • Patients receiving anticoagulants
  • Patients refusing spinal anaesthesia

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01440400

United Arab Emirates
Corniche hospital
Abu Dhabi, United Arab Emirates, 3788
Sponsors and Collaborators
Corniche Hospital
Principal Investigator: Tarek Ansari, FFARCSI Corniche Hospital
Principal Investigator: Mounir Fayez, MD Corniche Hospital
Principal Investigator: Amr Maher, MD Corniche Hospital
Principal Investigator: Ahmed El Gamassy, MD Corniche Hospital

Responsible Party: Dr. Tarek Ansari, Consultant anesthetist, Corniche Hospital Identifier: NCT01440400     History of Changes
Other Study ID Numbers: ch3151105
First Posted: September 26, 2011    Key Record Dates
Last Update Posted: March 12, 2013
Last Verified: March 2013

Keywords provided by Dr. Tarek Ansari, Corniche Hospital:
Spinal anesthesia
Cesarean section

Additional relevant MeSH terms:
Central Nervous System Depressants
Physiological Effects of Drugs