Neuraxial Anaesthesia: Does BMI Relate to Ease of Neuraxial Anaesthesia?

NCT03315845 | Unknown

• 1 other identifier: NationalMHI
• Study Type: observational
• Target: 100
• Locations: 0 countries
• Sites: N/A

Brief Summary

Neuraxial anaesthesia can be more difficult and associated with more complications if the patient's bony landmarks are difficult to palpate. They are more likely to be difficult to palpate if a patient has a high Body Mass Index (BMI), (\>30kg/m2). The depth that the spinal or epidural needle must be inserted is usually longer in these patients with high BMIs. We wish to palpate the backs of at least 100 such patients to see how many of them have impalpable bony landmarks. We then wish to use ultrasound to measure the distance from skin to the posterior epidural complex to discover if this length is longer than the standard needle length. If it is longer in the majority of people we study, we will recommend changing standard practice to start using a longer needle for all first attempts at neuraxial anaesthesia in this patient population.

Conditions

Obesity; Neuraxial Ultrasound; Obstetric Anaesthesia

Keywords

BMI; obstetric anaesthesia; neuraxial anaesthesia; neuraxial ultrasound; difficult neuraxial anaesthesia

Outcome Measures

Primary Outcomes (1)

• Palpability of bony landmarks for neuraxial anaesthesia

  The percentage of patients with BMI\>30kg/m2 who have difficult or impalpable bony landmarks including: lumbar spinous processes; anterior and posterior iliac spines; scapulae; and sacral cornua.

  4 months

Secondary Outcomes (1)

• Ultrasonographic distance from skin to posterior epidural complex

  4 months

Interventions

Palpation of bony landmarks for neuraxial anaesthesia. OTHER

Manual palpation of anterior and posterior iliac crests; lumbar spinous processes; scapulae; and sacral cornua. Ultrasound of neuraxial anatomy to assess depth to epidural space.

Also known as: Neuraxial ultrasound

Eligibility Criteria

• Age: 16 Years+
• Gender Eligibility Details: Obstetric patients.
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Obstetric patients with BMI \>30kg/m2, presenting in a non-emergency situation.

You may qualify if:

• Recorded BMI \>30kg/m2; ability to give consent; non-emergency cases.

You may not qualify if:

• Previous metal work to lumbar spine.

Sponsors & Collaborators

• National Maternity Hospital, Ireland: lead

Related Publications (8)

• Arzola C, Mikhael R, Margarido C, Carvalho JC. Spinal ultrasound versus palpation for epidural catheter insertion in labour: A randomised controlled trial. Eur J Anaesthesiol. 2015 Jul;32(7):499-505. doi: 10.1097/EJA.0000000000000119.

  PMID: 25036283 BACKGROUND

• Ansari T, Yousef A, El Gamassy A, Fayez M. Ultrasound-guided spinal anaesthesia in obstetrics: is there an advantage over the landmark technique in patients with easily palpable spines? Int J Obstet Anesth. 2014 Aug;23(3):213-6. doi: 10.1016/j.ijoa.2014.03.001. Epub 2014 Mar 12.

  PMID: 24768303 BACKGROUND

• Srinivasan KK, Lee PJ, Iohom G. Ultrasound for neuraxial blockade. Med Ultrason. 2014 Dec;16(4):356-63.

  PMID: 25463890 BACKGROUND

• Grau T, Leipold RW, Delorme S, Martin E, Motsch J. Ultrasound imaging of the thoracic epidural space. Reg Anesth Pain Med. 2002 Mar-Apr;27(2):200-6. doi: 10.1053/rapm.2002.29239.

  PMID: 11915069 BACKGROUND

• Carnie J, Boden J, Gao Smith F. Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion. Anaesthesia. 2002 Jul;57(7):701-4. doi: 10.1046/j.1365-2044.2002.02572_4.x.

  PMID: 12059829 BACKGROUND

• Gnaho A, Nguyen V, Villevielle T, Frota M, Marret E, Gentili ME. Assessing the depth of the subarachnoid space by ultrasound. Rev Bras Anestesiol. 2012 Jul;62(4):520-30. doi: 10.1016/S0034-7094(12)70150-2.

  PMID: 22793967 BACKGROUND

• Seligman KM, Weiniger CF, Carvalho B. The Accuracy of a Handheld Ultrasound Device for Neuraxial Depth and Landmark Assessment: A Prospective Cohort Trial. Anesth Analg. 2018 Jun;126(6):1995-1998. doi: 10.1213/ANE.0000000000002407.

  PMID: 28858898 BACKGROUND

• Balki M, Lee Y, Halpern S, Carvalho JC. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 2009 Jun;108(6):1876-81. doi: 10.1213/ane.0b013e3181a323f6.

  PMID: 19448216 BACKGROUND

MeSH Terms

Conditions

Obesity

Condition Hierarchy (Ancestors)

Overweight; Overnutrition; Nutrition Disorders; Nutritional and Metabolic Diseases; Body Weight; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Kevin McKeating

  National Maternity Hospital, Ireland

  STUDY DIRECTOR

Central Study Contacts

Moninne Creaney, MBBChBAOFCAI

CONTACT

00353879837656; creaneym@hotmail.com

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Dr. Moninne Creaney, Specialist Registrar in Anaesthesia

Study Record Dates

• First Submitted: October 17, 2017
• First Posted: October 20, 2017
• Study Start: October 23, 2017
• Primary Completion: January 9, 2018
• Study Completion: January 9, 2018
• Last Updated: October 24, 2017

Record last verified: 2017-10

Data Sharing

• IPD Sharing: Will not share