EVALUATION OF USE OF ULTRASOUND IMAGING IN SPINAL ANAESTHESIA IN PATIENTS WITH DIFFICULT SURFACE ANATOMICAL LANDMARKS.

Background: Indirect visualization of spinal canal with ultrasound can reduce difficulties and complications occurring due to blind nature of procedure. If an inter laminar window that permits passage of sound waves into the vertebral canal can be identified, the same window will permit passage of a needle into the intrathecal space. Aim: To evaluate the use of ultrasound imaging for ease of spinal anesthesia in patients with difficult surface anatomical landmarks. Methods: 60 patients of ASA I, II and III status with age more than 20 years, were divided in two groups; control group [Group LM] received spinal anaesthesia with conventional landmark guided method. In study group [Group US] pre-procedural ultrasound imaging of lumbar spine was done and point for lumbar puncture was identified and marked. Observations about number of needle attempts, number of needle redirections, time required etc. were recorded. Results: The number of patients requiring more than two needle attempts for successful puncture were significantly lower in USG guided group as compared to surface landmark group . The difference came out to be statistically significant (P = 0.039). Conclusion: Pre-procedure inter-vertebral space imaging of lumbar spine with USG can help us to reduce number of needle puncture, number of needle redirection, and will also reduce the procedure time, leading to lesser complication, and improved patient comfort.