A randomized comparison between Accuro and palpation-guided spinal anesthesia for obese patients undergoing orthopedic surgery

Daniela Ghisi, Marco Tomasi, Sandra Giannone, Alessandra Luppi, Lucia Aurini, Letizia Toccaceli, Andrea Benazzo, Stefano Bonarelli

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Although obese patients benefit from neuraxial anesthesia, technical difficulties often discourage its use. The current randomized trial compared Accuro, a hand-held, battery-operated ultrasound (US) device, and conventional palpation for spinal anesthesia in obese patients undergoing orthopedic surgery. We hypothesized that Accuro would decrease the number of needle redirections.

METHODS: We enrolled 130 men and women with a body mass index ≥30 kg/m2, scheduled for lower limb surgery under spinal block. Patients were randomized either to the Control group (group C: spinal block after palpation of cutaneous landmarks) or to the Accuro group (group A: preprocedural US scan with Accuro to identify the needle insertion point). The procedural time, the number of skin passes and of needle redirections, the occurrence of failure and adverse events were recorded.

RESULTS: Ninety-nine patients completed the study. Patients in group Accuro showed a median (IQR) number of redirections of 3 (0-9) and a median (IQR) number of needle passes through the skin of 1 (1-2) versus 6 (1-16) and 1 (1-3), respectively, in group Control (p=0.008, p=0.019). The performance time was 558±232 s in group Accuro versus 348±255 s in group Control (p<0.001). There were no intergroup differences in terms of failed blocks and adverse events.

CONCLUSIONS: The use of Accuro reduced the number of needle redirections and passes through the skin when performing spinal anesthesia, but required a longer procedural time.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT03075488).

Original languageEnglish
JournalRegional Anesthesia and Pain Medicine
DOIs
Publication statusE-pub ahead of print - Oct 25 2019

Fingerprint

Palpation
Spinal Anesthesia
Needles
Orthopedics
Skin
Control Groups
Registries
Lower Extremity
Body Mass Index
Anesthesia
Hand
Equipment and Supplies

Keywords

  • neuraxial blocks
  • spinal/epidural injection
  • technology

Cite this

A randomized comparison between Accuro and palpation-guided spinal anesthesia for obese patients undergoing orthopedic surgery. / Ghisi, Daniela; Tomasi, Marco; Giannone, Sandra; Luppi, Alessandra; Aurini, Lucia; Toccaceli, Letizia; Benazzo, Andrea; Bonarelli, Stefano.

In: Regional Anesthesia and Pain Medicine, 25.10.2019.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Although obese patients benefit from neuraxial anesthesia, technical difficulties often discourage its use. The current randomized trial compared Accuro, a hand-held, battery-operated ultrasound (US) device, and conventional palpation for spinal anesthesia in obese patients undergoing orthopedic surgery. We hypothesized that Accuro would decrease the number of needle redirections.METHODS: We enrolled 130 men and women with a body mass index ≥30 kg/m2, scheduled for lower limb surgery under spinal block. Patients were randomized either to the Control group (group C: spinal block after palpation of cutaneous landmarks) or to the Accuro group (group A: preprocedural US scan with Accuro to identify the needle insertion point). The procedural time, the number of skin passes and of needle redirections, the occurrence of failure and adverse events were recorded.RESULTS: Ninety-nine patients completed the study. Patients in group Accuro showed a median (IQR) number of redirections of 3 (0-9) and a median (IQR) number of needle passes through the skin of 1 (1-2) versus 6 (1-16) and 1 (1-3), respectively, in group Control (p=0.008, p=0.019). The performance time was 558±232 s in group Accuro versus 348±255 s in group Control (p<0.001). There were no intergroup differences in terms of failed blocks and adverse events.CONCLUSIONS: The use of Accuro reduced the number of needle redirections and passes through the skin when performing spinal anesthesia, but required a longer procedural time.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT03075488).",
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T1 - A randomized comparison between Accuro and palpation-guided spinal anesthesia for obese patients undergoing orthopedic surgery

AU - Ghisi, Daniela

AU - Tomasi, Marco

AU - Giannone, Sandra

AU - Luppi, Alessandra

AU - Aurini, Lucia

AU - Toccaceli, Letizia

AU - Benazzo, Andrea

AU - Bonarelli, Stefano

N1 - © American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/10/25

Y1 - 2019/10/25

N2 - BACKGROUND: Although obese patients benefit from neuraxial anesthesia, technical difficulties often discourage its use. The current randomized trial compared Accuro, a hand-held, battery-operated ultrasound (US) device, and conventional palpation for spinal anesthesia in obese patients undergoing orthopedic surgery. We hypothesized that Accuro would decrease the number of needle redirections.METHODS: We enrolled 130 men and women with a body mass index ≥30 kg/m2, scheduled for lower limb surgery under spinal block. Patients were randomized either to the Control group (group C: spinal block after palpation of cutaneous landmarks) or to the Accuro group (group A: preprocedural US scan with Accuro to identify the needle insertion point). The procedural time, the number of skin passes and of needle redirections, the occurrence of failure and adverse events were recorded.RESULTS: Ninety-nine patients completed the study. Patients in group Accuro showed a median (IQR) number of redirections of 3 (0-9) and a median (IQR) number of needle passes through the skin of 1 (1-2) versus 6 (1-16) and 1 (1-3), respectively, in group Control (p=0.008, p=0.019). The performance time was 558±232 s in group Accuro versus 348±255 s in group Control (p<0.001). There were no intergroup differences in terms of failed blocks and adverse events.CONCLUSIONS: The use of Accuro reduced the number of needle redirections and passes through the skin when performing spinal anesthesia, but required a longer procedural time.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT03075488).

AB - BACKGROUND: Although obese patients benefit from neuraxial anesthesia, technical difficulties often discourage its use. The current randomized trial compared Accuro, a hand-held, battery-operated ultrasound (US) device, and conventional palpation for spinal anesthesia in obese patients undergoing orthopedic surgery. We hypothesized that Accuro would decrease the number of needle redirections.METHODS: We enrolled 130 men and women with a body mass index ≥30 kg/m2, scheduled for lower limb surgery under spinal block. Patients were randomized either to the Control group (group C: spinal block after palpation of cutaneous landmarks) or to the Accuro group (group A: preprocedural US scan with Accuro to identify the needle insertion point). The procedural time, the number of skin passes and of needle redirections, the occurrence of failure and adverse events were recorded.RESULTS: Ninety-nine patients completed the study. Patients in group Accuro showed a median (IQR) number of redirections of 3 (0-9) and a median (IQR) number of needle passes through the skin of 1 (1-2) versus 6 (1-16) and 1 (1-3), respectively, in group Control (p=0.008, p=0.019). The performance time was 558±232 s in group Accuro versus 348±255 s in group Control (p<0.001). There were no intergroup differences in terms of failed blocks and adverse events.CONCLUSIONS: The use of Accuro reduced the number of needle redirections and passes through the skin when performing spinal anesthesia, but required a longer procedural time.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT03075488).

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