A researcher examined the study from an Optimal patient positioning is perceived as an essential factor to increase the success of performing neuraxial blockade. A main aim of this study was to evaluate the benefit of using a visual image in addition to verbal instructions to optimize positioning for spinal block. Patient positioning can also independently predict the success of performing neuraxial anesthesia.
Anesthesiologists traditionally perform neuraxial block utilising landmark- based techniques and the most significant predictor of the difficulty in performing them has been reported to be the quality of these landmarks. Patients are often verbally instructed by the anesthesiologist to adopt an optimal position for neuraxial blocks.
Difficulty can be encountered in achieving the best position if patients misunderstand these instructions. This may lead to a delay in performing the procedure and increase the technical difficulty with a possible increased risk of complications. Further, it may result in the anesthesiologist abandoning the procedure despite the possible advantage of neuraxial anesthesia for the patient.
Multiple punctures can lower patient satisfaction and may lead to complications such as hematoma, paresthesia and nerve injury as well as post dural puncture headache. 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.
Our study demonstrated that the use of a simple visual aid in conjunction with verbal instructions resulted in improved positioning of patients undergoing spinal anesthesia as measured by significantly reduced time taken for the procedure, improved ease of spinal needle placement with fewer skin punctures and reduced need for assistance from a second more experienced anesthesiologist.
The results in our study are consistent with those of a similar study on obstetric patients undergoing epidural anesthesia for caesarean section in which use of visual image resulted in a reduction in both time taken and number of needle punctures, though not statistically significant at the 5% level. However, our study includes general surgical patients with different demographic and clinical characteristics.
Study concludes that the use of visual aids to assist positioning for neuraxial blockade reduced the time taken for the procedure by an average of 2 min and reduced the number of skin punctures required.
The use of a visual image also resulted in a 100% success rate for the first anesthesiologist without the need for a second anesthesiologist to intervene. Initial success was strongly associated with patient satisfaction.