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Neuraxial Anaesthesia: Does BMI Relate to Ease of Neuraxial Anaesthesia?

NCT ID: NCT03315845

Last Updated: 2017-10-24

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

100 participants

Study Classification

OBSERVATIONAL

Study Start Date

2017-10-23

Study Completion Date

2018-01-09

Brief Summary

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Neuraxial anaesthesia can be more difficult and associated with more complications if the patient's bony landmarks are difficult to palpate. They are more likely to be difficult to palpate if a patient has a high Body Mass Index (BMI), (\>30kg/m2). The depth that the spinal or epidural needle must be inserted is usually longer in these patients with high BMIs. We wish to palpate the backs of at least 100 such patients to see how many of them have impalpable bony landmarks. We then wish to use ultrasound to measure the distance from skin to the posterior epidural complex to discover if this length is longer than the standard needle length. If it is longer in the majority of people we study, we will recommend changing standard practice to start using a longer needle for all first attempts at neuraxial anaesthesia in this patient population.

Detailed Description

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Complications rates including failure are higher in obese patients undergoing anaesthesia procedures. Anaesthetists have adopted the use of ultrasound to assist in overcoming these difficulties. Neuraxial ultrasound is proving to be beneficial in those patients in whom identification of interspinous spaces is difficult and most of these patients are obese.

In our institution, there is a 'standard practice' for neuraxial procedures, with a 'standard' needle used for first attempts (Whitacre 25G 90mm for spinal, Tuohy 18G 80mm for epidural). If the operator has not reached the desired space (spinal or epidural) with the needle inserted to 8cm, a longer needle is then considered for further attempts. This exposes the patient to at least one extra neuraxial needle insertion. Studies have shown that increased needle insertions and redirections are associated with increased complications.

We hypothesised that a large number of patients with BMI\>30kg/m2 would have a depth of spinal/epidural space that is greater than the length of the 'standard' needle used. Therefore we suggest that practice should change to use the longer needle or a combined spinal-epidural on the first attempt in these patients.

To test our hypothesis, we will assess the ease of palpation of the following anatomical landmarks: anterior and posterior iliac crests; lumbar spinous processes; scapulae; and sacral cornua. We will then perform neuraxial sonography of the lumbar spine, measuring depth to epidural space. Finally we will measure waist circumference in those patients with BMI \<30kg/m2.

Conditions

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Obesity Neuraxial Ultrasound Obstetric Anaesthesia

Keywords

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BMI obstetric anaesthesia neuraxial anaesthesia neuraxial ultrasound difficult neuraxial anaesthesia

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Interventions

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Palpation of bony landmarks for neuraxial anaesthesia.

Manual palpation of anterior and posterior iliac crests; lumbar spinous processes; scapulae; and sacral cornua.

Ultrasound of neuraxial anatomy to assess depth to epidural space.

Intervention Type OTHER

Other Intervention Names

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Neuraxial ultrasound

Eligibility Criteria

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Inclusion Criteria

* Recorded BMI \>30kg/m2; ability to give consent; non-emergency cases.

Exclusion Criteria

* Previous metal work to lumbar spine.
Minimum Eligible Age

16 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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National Maternity Hospital, Ireland

OTHER

Sponsor Role lead

Responsible Party

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Moninne Creaney

Dr. Moninne Creaney, Specialist Registrar in Anaesthesia

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Kevin McKeating

Role: STUDY_DIRECTOR

National Maternity Hospital, Ireland

Central Contacts

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Moninne Creaney, MBBChBAOFCAI

Role: CONTACT

Phone: 00353879837656

Email: [email protected]

References

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Arzola C, Mikhael R, Margarido C, Carvalho JC. Spinal ultrasound versus palpation for epidural catheter insertion in labour: A randomised controlled trial. Eur J Anaesthesiol. 2015 Jul;32(7):499-505. doi: 10.1097/EJA.0000000000000119.

Reference Type BACKGROUND
PMID: 25036283 (View on PubMed)

Ansari T, Yousef A, El Gamassy A, Fayez M. Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth. 2014 Aug;23(3):213-6. doi: 10.1016/j.ijoa.2014.03.001. Epub 2014 Mar 12.

Reference Type BACKGROUND
PMID: 24768303 (View on PubMed)

Srinivasan KK, Lee PJ, Iohom G. Ultrasound for neuraxial blockade. Med Ultrason. 2014 Dec;16(4):356-63.

Reference Type BACKGROUND
PMID: 25463890 (View on PubMed)

Grau T, Leipold RW, Delorme S, Martin E, Motsch J. Ultrasound imaging of the thoracic epidural space. Reg Anesth Pain Med. 2002 Mar-Apr;27(2):200-6. doi: 10.1053/rapm.2002.29239.

Reference Type BACKGROUND
PMID: 11915069 (View on PubMed)

Carnie J, Boden J, Gao Smith F. Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion. Anaesthesia. 2002 Jul;57(7):701-4. doi: 10.1046/j.1365-2044.2002.02572_4.x.

Reference Type BACKGROUND
PMID: 12059829 (View on PubMed)

Gnaho A, Nguyen V, Villevielle T, Frota M, Marret E, Gentili ME. Assessing the depth of the subarachnoid space by ultrasound. Rev Bras Anestesiol. 2012 Jul;62(4):520-30. doi: 10.1016/S0034-7094(12)70150-2.

Reference Type BACKGROUND
PMID: 22793967 (View on PubMed)

Seligman KM, Weiniger CF, Carvalho B. The Accuracy of a Handheld Ultrasound Device for Neuraxial Depth and Landmark Assessment: A Prospective Cohort Trial. Anesth Analg. 2018 Jun;126(6):1995-1998. doi: 10.1213/ANE.0000000000002407.

Reference Type BACKGROUND
PMID: 28858898 (View on PubMed)

Balki M, Lee Y, Halpern S, Carvalho JC. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 2009 Jun;108(6):1876-81. doi: 10.1213/ane.0b013e3181a323f6.

Reference Type BACKGROUND
PMID: 19448216 (View on PubMed)

Other Identifiers

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NationalMHI

Identifier Type: -

Identifier Source: org_study_id