Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly
Vol 4 | Issue 2 | July-December 2023 | Page 9-13 | Tamasi Dawn, Yatindra Kumar Batra, Sunny Rupal, Komal Jit Kaur, Tanvir Samra
DOI: https://doi.org/10.13107/ijra.2023.v04i02.076
Submitted: 10-08-2023; Reviewed: 06-09-2023; Accepted: 24-10-2023; Published: 10-12-2023
Authors: Tamasi Dawn [1], Yatindra Kumar Batra [1], Sunny Rupal [1], Komal Jit Kaur [1], Tanvir Samra [2]
[1] Department of Anaethesiology Max superspeciality Hospital, Mohali, Punjab, India.
[2] Department of Anaesthesia PGIMER, Chandigarh, India.
Address of Correspondence
Dr. Tanvir Samra,
Associate Professor Department of Anaesthesia PGIMER, Chandigarh, India.
E-mail: drtanvirsamra@yahoo.co.in
Abstract
Background- The ability of the pendant position in increasing the intervertebral spaces translating in an increase in the 1st attempt spinal puncture success rate has been reported in pregnant females undergoing cesarean section. However, the same has not been done for the elderly patients in which age-related degenerative anatomical changes, decreased lordosis, disseminated sclerosis, and extensive osteophytosis is known to reduce the intervertebral space.
Materials and Methods- A prospective randomized controlled study was conducted in patients aged 60-80 years undergoing urological surgeries after approvalfrom the Institutional Ethics Committee and written informed consent from the patients. Primary aim was to compare the number of bone contacts during administration of subarachnoid block with the patient in either pendant (Group A) or traditional (Group B) position. Secondary aims were to compare the proportion of successful spinal needle placements, ease of palpation of spinous processes, patient’s comfort, number of spaces used, time to perform spinal puncture, time to reach grade III (as per modified bromage score) motor blockade, time to reach T10 sensory level and rate of complications in both the groups.
Results- Demographic data was comparable and there was no statistical difference in number of bone contacts, ease of administration, success of spinal needle placements, performance times of subarachnoid block and duration of spinal anaesthesia in both the groups. Complication rates were comparable.
Conclusion- Pendant positioning does not confer any advantage over the traditional sitting position in success rates and performance characteristics of subarachnoid block in elderly (60-80 years) patients scheduled for urological surgeries.
Keywords: Pendant position, Spinal-bone contact, Spinal Needle Puncture, Lumbar puncture, Spinal anesthesia, Aged
References
1. de Filho GR, Gomes HP, da Fonseca MH, Hoffman JC, Pederneiras SG, Garcia JH. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002 ;19:447–51.
2. Lerner S, Gutlerman P, Jenkins F. Epidural hematoma and paraplegia after numerous lumbar punctures. Anesthesiology. 1973; 39:550-1.
3. Owens E, Kasten G, Hessel E II. Spinal subarachnoid hematoma after lumbar puncture and heparinization. AnesthAnalg. 1986; 65:1201-7.
4. Flaatten H, Felthaus J, Larsen R, Bernhardsen S, Klausen H. Postural post-dural puncture headache after spinal and epidural anaesthesia. A randomised, double-blind study. Acta Anaesthesiol Scand. 1998;42:759–64.
5. Flaatten H, Berg CM, Brekke S, Holmaas G, Natvik C, Varughese K. Effect of experience with spinal anaesthesia on the development of post-dural puncture complications. Acta Anaesthesiol Scand. 1999;43:37–41.
6. Horlocker TT, McGregor DG, Matsushige DK, Schroeder DR, Besse JA. A retrospective review of 4767 consecutive spinal anesthetics: central nervous system complications. Perioperative Outcomes Group. AnesthAnalg. 1997;84:578–84.
7. Pryambodho P, Mahdi Nugroho A, Januarrifianto D. Comparison Between Pendant Position and Traditional Sitting Position for Successful Spinal Puncture in Spinal Anesthesia for Cesarean Section. Anesth Pain Med. 2017;7:e14300.
8. Arshad QUA, Jadoon H, Raza A, Furqan Z, Shahani YA. Comparison of successful spinal puncture betweenpendant position and traditionalsitting position for cesarean deliveries. Anaesth. pain intensive care 2020;24:603-610
9. Shabanian G, Saadat M. A Position for Administration of Difficult Spinal Anesthesia. J Clin Diagn Res. 2014;8:190–1.
10. Park CO. Diurnal variation in lumbar MRI. Correlation between signal intensity, disc height, and disc bulge. Yonsei Med J. 1997;38:8–18.
11. Movasseghi G, Hassani V, Mohaghegh MR, Safaeian R, Safari S, Zamani MM, et al. Comparison Between Spinal and General Anesthesia in Percutaneous Nephrolithotomy. Anesth Pain Med2013;4:e13871.
12. Chohedri A, RaeesiEstabragh R, Eghbal MH, Sahmeddini MA, Eftekharian H, Shahabifar R. Comparing the Duration of Spinal Anesthesia Induced With Bupivacaine and a Bupivacaince- Lidocaine Combination in Trans-Urethral Resection of the Prostate (TURP). Anesth Pain Med 2015;5: e25675.
13. Faiz SH, Rahimzadeh P, Sakhaei M, Imani F, Derakhshan P. Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries. J Res Med Sci. 2012;17:918–22.
14. Tessler MJ, Kardash K, Wahba RM, Kleiman SJ, Trihas ST, Rossignol M. The performance of spinal anesthesia is marginally more difficult in the elderly. Reg Anesth Pain Med. 1999; 24:126-30.
15. Chin KJ, Karmakar MK, Peng P. Ultrasonography of the adult thoracic and lumbar spine for central neuraxial blockade. Anesthesiology. 2011;114:1459–85.
16. Butterworth JF, Mackey DC, Wasnick JD. Anesthesia for genitourinary surgery. In: Butterworth JF, Mackey DC, Wasnick JD, editors. Morgan and Mikhail’s Clinical Anesthesiology. US: McGraw-Hill Education; 2013. pp. 671–90.
17. Fisher KS, Arnholt AT, Douglas ME, Vandiver SL, Nguyen DH. A randomized trial of the traditional sitting position versus the hamstring stretch position for labor epidural needle placement. AnesthAnalg. 2009;109:532–4
How to Cite this Article: Dawn T, Batra YK, Rupal S, Kaur KJ, Samra T | Pendant Positioning Vs Traditional Sitting for Successful Spinal Punctures in Elderly | International Journal of Regional Anaesthesia | July- December 2023; 4(2): 9-13 | DOI: https://doi.org/10.13107/ijra.2023.v04i02.076 |