Ultrasound Versus Palpation for Spinal Anesthesia Success
Ultrasound Versus Palpation for Spinal Anesthesia Success
Aim is to investigate the difference in number of attempts to place neuraxial block comparing
 handheld ultrasound versus use of palpation alone for women with impalpable bony landmarks
 undergoing spinal anesthesia for elective cesarean delivery.
Patients will be recruited prior to cesarean delivery and their site of lumbar injection will
 be examined. Women with impalpable bony landmarks will be offered recruitment to the study.
 Women will be randomly assigned to the standard of care group - palpation attempts only,
 versus an ultrasound group, where the insertion point will be identified by the handheld
 ultrasound device

 Inclusion criteria:

 Lumbar spinous processes impalpable. Elective cesarean delivery for singleton pregnancies BMI
 >30 No contraindications to neuraxial block Signed informed consent Neuraxial Block planned
 Exclusion Criteria Refuses informed consent Poor written Hebrew, no spoken English or Hebrew
 Patients will be randomized into two groups : an ultrasound (US) group and a palpation (PP)
 group.

 The primary outcome of our study is the number of needle redirections, defined as any ventral
 advancement of the needle and/or introducer, as well as any new intervertebral space
 attempted.

 Secondary outcomes include:

 The insertion site identification time, patient verbal numerical pain score (0-10) after skin
 incision.
Inclusion Criteria:

 Lumbar spinous processes impalpable. Elective caesarean delivery for singleton pregnancies
 BMI >30 No contraindications to neuraxial block Signed informed consent Neuraxial Block
 planned