Patients in this group underwent Conventional landmark guided midline spinal anaesthesia.

This group had pre-procedure ultrasound guided L5S1 paramedian spinal anaesthesia performed

Anaesthesia

Spinal anaesthesia was administered based on conventional landmark based midline approach.

Conventional landmark guided midline spinal anaesthesia

In group P, a portable ultrasound unit was used for initial pre-procedural marking. The L5 S1 interspinous space with best image of the anterior complex (ligamentum flavum dura complex- LFD) and posterior complex (posterior longitudinal ligament- PLL) was obtained. At this selected interspace, and with the probe positioned to obtain the clearest ultrasound image, a skin marker was used to mark the midpoint of the long border of the probe and the midpoints of the short borders of the probe . At the same horizontal level as the midpoint of the long border of the probe, the midpoint of the line drawn between the two short border midpoints of the probe was used as paramedian insertion point for the spinal needle.Spinal anaesthesia is then administered based on these landmarks.

pre-procedure ultrasound guided L5S1 paramedian spinal

Spinal anaesthesia is administered with appropriate spinal needle

spinal anaesthesia

Cork University Hospital

Landmark Guided Midline Versus Pre-procedural Ultrasound Guided Paramedian at L5S1 for Spinal Anaesthesia

Comparison of Conventional Landmark Guided Midline (Group C) Versus Pre-procedural Ultrasound Guided Paramedian at L5S1 (Group P) Technique for Spinal Anaesthesia

The number of passes, defined as the number of forward advancements of the spinal needle in a given interspinous space (i.e. withdrawal and redirection of spinal needle without exiting the skin)

number of spinal needle insertion attempts (defined as the number of times the spinal needle was withdrawn from the skin and reinserted) were noted

Time for identifying landmarks in group C was defined as time from which the anesthesiologist started palpating to identify the landmarks to completion of the process as declared by the anesthesiologist. In group P it was defined as time from which the ultrasound probe was placed on the skin to the anesthesiologist declaring that the markings are completed

defined as time taken from insertion of introducer needle to completion of injection

Shooting pain going down along one of the dermatomal levels in the leg

Paresthesia along dermatomal distribution during performing spinal anaesthetic

Anesthesiologist palpated the landmarks after positioning and graded the ease of palpation on a 4 point scale (easy, moderate, difficult or impossible)

After positioning and prior to administration of sedation, patients were asked for their peri-procedural pain scores measured using an 11 point verbal rating scale (0=no pain, 10=most pain imaginable)

peri-procedural discomfort scores measured using an 11 point verbal rating measured (0= no discomfort, 10=most discomfort imaginable).

Dermatomal level at which loss of cold sensation (ethyl chloride spray) occurs

Karthikeyan Kallidaikurichi Srinivasan

Specialist Registrar,Anaesthetics,Cork University Hospital

Dexamethasone 10 mg
Dexamethasone: Dexamethasone 10mg IV

Dexamethasone

Placebo Dexamethasone, 10 mg
Placebo: Placebo Dexamethasone 10mg IV

Placebo

Total

Sex: Female, Male

Race and Ethnicity Not Collected

Region of Enrollment

Duration of headache Prior to Study

Achieve headache freedom within two hours in the emergency department and no recurrence of pain within 24 hours of emergency department discharge

Persistent Headache Pain Free at 24 Hours

No functional impairment within 24 hours of emergency department discharge

papillon-lefevre disease/kopfschmerz

Landmark Guided Midline Versus Pre-procedural Ultrasound Guided Paramedian at L5S1 for Spinal Anaesthesia

Headache in the Emergency Department (ED) - A Multi-Center Research Network to Optimize the ED Treatment of Migraines

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