Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial
Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Gurunathan, Usha [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2018 |
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| Schlagwörter: |
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| Anmerkung: |
© The Author(s) 2018 |
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| Übergeordnetes Werk: |
Enthalten in: BMC anesthesiology - [S.l.] : BioMed Central, 2001, 18(2018), 1 vom: 20. Jan. |
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| Übergeordnetes Werk: |
volume:18 ; year:2018 ; number:1 ; day:20 ; month:01 |
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| DOI / URN: |
10.1186/s12871-017-0467-3 |
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| Katalog-ID: |
SPR027324273 |
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| 520 | |a Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). | ||
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| 700 | 1 | |a Hay, Karen Elizabeth |4 aut | |
| 700 | 1 | |a van Alphen, Sharyn |4 aut | |
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10.1186/s12871-017-0467-3 doi (DE-627)SPR027324273 (SPR)s12871-017-0467-3-e DE-627 ger DE-627 rakwb eng Gurunathan, Usha verfasserin (orcid)0000-0002-0336-872X aut Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2018 Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). Anesthesia (dpeaa)DE-He213 Patient positioning (dpeaa)DE-He213 Anesthesia (dpeaa)DE-He213 Spinal (dpeaa)DE-He213 Kunju, Shakeel Meeran aut Hay, Karen Elizabeth aut van Alphen, Sharyn aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 18(2018), 1 vom: 20. Jan. (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:18 year:2018 number:1 day:20 month:01 https://dx.doi.org/10.1186/s12871-017-0467-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 18 2018 1 20 01 |
| spelling |
10.1186/s12871-017-0467-3 doi (DE-627)SPR027324273 (SPR)s12871-017-0467-3-e DE-627 ger DE-627 rakwb eng Gurunathan, Usha verfasserin (orcid)0000-0002-0336-872X aut Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2018 Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). Anesthesia (dpeaa)DE-He213 Patient positioning (dpeaa)DE-He213 Anesthesia (dpeaa)DE-He213 Spinal (dpeaa)DE-He213 Kunju, Shakeel Meeran aut Hay, Karen Elizabeth aut van Alphen, Sharyn aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 18(2018), 1 vom: 20. Jan. (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:18 year:2018 number:1 day:20 month:01 https://dx.doi.org/10.1186/s12871-017-0467-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 18 2018 1 20 01 |
| allfields_unstemmed |
10.1186/s12871-017-0467-3 doi (DE-627)SPR027324273 (SPR)s12871-017-0467-3-e DE-627 ger DE-627 rakwb eng Gurunathan, Usha verfasserin (orcid)0000-0002-0336-872X aut Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2018 Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). Anesthesia (dpeaa)DE-He213 Patient positioning (dpeaa)DE-He213 Anesthesia (dpeaa)DE-He213 Spinal (dpeaa)DE-He213 Kunju, Shakeel Meeran aut Hay, Karen Elizabeth aut van Alphen, Sharyn aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 18(2018), 1 vom: 20. Jan. (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:18 year:2018 number:1 day:20 month:01 https://dx.doi.org/10.1186/s12871-017-0467-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 18 2018 1 20 01 |
| allfieldsGer |
10.1186/s12871-017-0467-3 doi (DE-627)SPR027324273 (SPR)s12871-017-0467-3-e DE-627 ger DE-627 rakwb eng Gurunathan, Usha verfasserin (orcid)0000-0002-0336-872X aut Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2018 Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). Anesthesia (dpeaa)DE-He213 Patient positioning (dpeaa)DE-He213 Anesthesia (dpeaa)DE-He213 Spinal (dpeaa)DE-He213 Kunju, Shakeel Meeran aut Hay, Karen Elizabeth aut van Alphen, Sharyn aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 18(2018), 1 vom: 20. Jan. (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:18 year:2018 number:1 day:20 month:01 https://dx.doi.org/10.1186/s12871-017-0467-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 18 2018 1 20 01 |
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10.1186/s12871-017-0467-3 doi (DE-627)SPR027324273 (SPR)s12871-017-0467-3-e DE-627 ger DE-627 rakwb eng Gurunathan, Usha verfasserin (orcid)0000-0002-0336-872X aut Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2018 Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). Anesthesia (dpeaa)DE-He213 Patient positioning (dpeaa)DE-He213 Anesthesia (dpeaa)DE-He213 Spinal (dpeaa)DE-He213 Kunju, Shakeel Meeran aut Hay, Karen Elizabeth aut van Alphen, Sharyn aut Enthalten in BMC anesthesiology [S.l.] : BioMed Central, 2001 18(2018), 1 vom: 20. Jan. (DE-627)355422115 (DE-600)2091252-3 1471-2253 nnns volume:18 year:2018 number:1 day:20 month:01 https://dx.doi.org/10.1186/s12871-017-0467-3 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 18 2018 1 20 01 |
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Usefulness of a visual aid in achieving optimal positioning for spinal anesthesia: a randomized trial |
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Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). © The Author(s) 2018 |
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Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). © The Author(s) 2018 |
| abstract_unstemmed |
Background Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. The primary objective of this study was to evaluate the benefit of using a visual image in addition to verbal instructions in order to optimize positioning for spinal block. Methods This was a prospective randomized controlled trial on 85 adult patients undergoing lower limb joint replacements at a tertiary academic hospital. Group 1(n = 43) randomized to receive standardized verbal instructions; Group 2 (n = 42) received standardized verbal instructions in conjunction with visual aids to achieve positioning for spinal anesthesia. The primary outcome measure was the time taken to successful dural puncture. Secondary endpoints were the number of skin punctures, number of intervertebral levels attempted, success at the first intervertebral space attempted and satisfaction of patients and anesthesiologists. Results The unadjusted geometric mean time taken for the procedure using verbal instruction alone was 301 s (95% CI: 236–385) compared to 183 s (95% CI: 143–235) when both verbal and visual instructions were used. Out of the participants in group 2, 90% required ≤2 skin punctures and 10% required ≥3 skin punctures compared to 65% and 35% of the participants in group 1 respectively (p = 0.001). Group 1 required a second anesthesiologist to successfully complete the procedure in 6 patients out of 43 (14%) patients whereas the first anesthesiologist was noted to be successful in all the 42 cases in group 2 (p = 0.03). There were no significant differences in the satisfaction scores of anesthesiologists or patients between the groups. First-pass success was strongly associated with patient satisfaction (Odds ratio: 5.2; 95% CI: 1.0–9.5, p = 0.049). Conclusions Use of a visual aid in addition to verbal instructions to optimize positioning for a spinal block, significantly reduces the time taken for the procedure by an average of 2 min, reduces the number of skin punctures and increases the success rate of the first anesthesiologist. First pass success was strongly associated with patient satisfaction. Trial registration This study was retrospectively registered 30 August 2016, with the Australian New Zealand Clinical trials registry (ACTRN12616001197426). © The Author(s) 2018 |
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Kunju, Shakeel Meeran Hay, Karen Elizabeth van Alphen, Sharyn |
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