scholarly journals Landmark-guided Versus Modified Ultrasound-assisted Paramedian Techniques in Combined Spinal-epidural Anesthesia for Elderly Patients with Hip Fractures: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Bo Qu ◽  
Luying Chen ◽  
Yuling Zhang ◽  
Mengting Jiang ◽  
Caineng Wu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Success Rate ◽  
Hip Fractures ◽  
Controlled Trial ◽  
Median Number ◽  
Needle Insertion ◽  
Success Rates ◽  
First Pass ◽  
Ultrasound Assisted ◽  
Ultrasound Group

Abstract Background: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods: This prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥ 65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.Results: 80 patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20% and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5% and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1[1,1]) than landmark-guided group (2[1,2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1[1,2]) than in landmark-guided group (3[2,4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4–5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.Conclusions: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registration: Chinese Clinical Trial Register (identifier, ChiCTR1900020819; date of registration, January 20, 2019).

scholarly journals Landmark-guided versus modified ultrasound-assisted Paramedian techniques in combined spinal-epidural anesthesia for elderly patients with hip fractures: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bo Qu ◽  
Luying Chen ◽  
Yuling Zhang ◽  
Mengting Jiang ◽  
Caineng Wu ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Success Rate ◽  
Hip Fractures ◽  
Controlled Trial ◽  
Median Number ◽  
Needle Insertion ◽  
Success Rates ◽  
First Pass ◽  
Ultrasound Assisted ◽  
Ultrasound Group

Abstract Background Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures due to spine degeneration and limitations in positioning. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods This prospective, single-blinded, parallel-group randomized controlled trial included 80 patients (aged ≥65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation. Results Eighty patients completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20 and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5 and 85%, respectively (P < 0.001). The median number of attempts was lower in ultrasound-assisted group (1 [1, 1]) than landmark-guided group (2 [1, 2]), P < 0.001). The median number of needle passes was lower in ultrasound group (1 [1, 2]) than in landmark-guided group (3 [2, 4], P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a high satisfaction score of 4–5 (P = 0.007). Interestingly, subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis. Conclusions Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice. Trial registration Chinese Clinical Trial Register (identifier, ChiCTR1900020819; date of registration, January 20, 2019).

scholarly journals Preprocedural Ultrasound Guidance for Combined Spinal-Epidural Anesthesia Results in Better Success Rates in Elderly Patients with Hip Fracture: A Randomized Controlled Trial

2020 ◽  
Author(s):  
Bo Qu ◽  
Luying Chen ◽  
Yuling Zhang ◽  
Mengting Jiang ◽  
Caineng Wu ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Success Rate ◽  
Adverse Reactions ◽  
Controlled Trial ◽  
Needle Insertion ◽  
Success Rates ◽  
First Pass ◽  
Spinal Epidural ◽  
Ultrasound Group

Abstract Background: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods: This prospective, single-blind, parallel-group randomized controlled trial included 80 patients (aged ≥ 65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into either the landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.Results: All patients,40 in each group, completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20% and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5% and 85%, respectively (P < 0.001). The number of needle insertion attempts and passes in the landmark group were 2 (1, 2) and 3 (2, 4), respectively; values of 1 (1, 1) and 1 (1, 2) were documented for the ultrasound group (median [interquartile range], all P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a satisfaction score of 4–5 (P = 0.007). Subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.Conclusions: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registration: Chinese Clinical Trial Register, ChiCTR1900020819. Registered January 20, 2019, http://www.chictr.org.cn/showprojen.aspx?proj=34634

Does Preprocedural Ultrasound Increase the First-Pass Success Rate of Epidural Catheterization Before Cesarean Delivery? A Randomized Controlled Trial

2017 ◽  
Vol 124 (3) ◽  
pp. 851-856 ◽  
Author(s):  
Mohamed Mohamed Tawfik ◽  
Magdy Mamdouh Atallah ◽  
Walaa Safaa Elkharboutly ◽  
Nasser Sameh Allakkany ◽  
Mostafa Abdelkhalek
Keyword(s):  
Randomized Controlled Trial ◽  
Success Rate ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
First Pass ◽  
Epidural Catheterization

scholarly journals Hyperpronation versus Supination–Flexion in Radial Head Subluxation Reduction: A Randomized Controlled Trial

2020 ◽  
Vol 09 (04) ◽  
pp. 256-260
Author(s):  
Samaneh Porozan ◽  
Arash Forouzan ◽  
Rayeheh Hassanzadeh
Keyword(s):  
Success Rate ◽  
Radial Head ◽  
Controlled Trial ◽  
Reduction Technique ◽  
Extremity Injury ◽  
Success Rates ◽  
Randomized Controlled ◽  
Before And After ◽  
Upper Extremity Injury ◽  
Successful Reduction

AbstractRadial head subluxation (RHS) is the most common upper extremity injury in children. Supination–flexion (SF) and hyperpronation (HP) are two methods for reducing this subluxation. This study purposed to compare the success rates of two methods of reduction and also to determine which technique would be less painful. In total, 154 patients with RHS were enrolled in this study and randomized into two groups. Patients were to undergo reduction by one of the two methods; if the primary attempt was unsuccessful, a second attempt was performed using the alternate technique. In the case of failure of the second attempt, the first reduction technique was repeated. The success rates and pain levels before and after successful reduction were recorded. On the first attempt, 72 of 77 patients who underwent HP had a successful reduction. Four patients in the HP group had a successful reduction on the second attempt. In the SF group, 76 of 77 patients had a successful reduction on the first attempt. The success rate on first attempts was higher in the SF group than in the HP group (p = 0.043). Pain levels before and after reduction were not statistically different between the groups (p > 0.05). The SF technique had a higher success rate at first attempt to reduce RHS, but pain levels were similar in both methods.

scholarly journals A preinstalled nasopharyngeal airway in the right nasal passageway to facilitate nasogastric intubation in anesthetized and intubated patients: a prospective randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ting-Yang Huang ◽  
Jr-Rung Lin ◽  
Yung-Tai Chung
Keyword(s):  
Randomized Controlled Trial ◽  
Success Rate ◽  
Risk Reduction ◽  
Controlled Trial ◽  
Success Rates ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Nasopharyngeal Airway ◽  
The Right ◽  
To Receive

Abstract Background Nasogastric intubation (NGI) is usually challenging in patients under general anesthesia, with reported success rate at the first attempt to be less than 50%. The aim of this study was to investigate whether a preinstalled nasopharyngeal airway (NPA) in the right nasal passageway can facilitate NGI in anesthetized and intubated patients. Methods A prospective randomized controlled trial including 108 patients scheduled for elective intra-abdominal surgeries requiring a nasogastric tube (NGT) was conducted. Fifty-three patients were randomized to receive NGI through a preinstalled NPA in the right nasal passageway (Group NPA) and 55 patients to receive NGI via the right nostril (Group O). The primary outcomes were success rates of NGI at first attempt, success rates of NGI in accumulative attempts, durations of successful NGI at the first attempt and success rates of NGI for the rescuing methods. The secondary outcomes were bleeding incidence and hemodynamic changes induced by NGI. Results Success rate of NGI at the first attempt was 83.0% in Group NPA compared with 47.3% in Group O [P < 0.001; absolute risk reduction (ARR) = 35.7%, 95% confidence interval (CI) = 19.1–52.4%; relative risk reduction (RRR) = 67.8%] and success rate of NGI in accumulative attempts (two attempts maximum) was 88.7% in Group NPA compared with 63.6% in Group O (P = 0.002; ARR = 25.0%, 95% CI = 9.7–40.4%; RRR = 68.9%). Duration for NGI successful at the first attempt in Group NPA was significantly longer than that in Group O (56.3 vs. 27.1 s; P < 0.001; Mean difference = 29.2 s, 95% CI = 20.0–38.4 s). Neither bleeding incidence nor hemodynamic response is significantly different between the two study groups. Conclusions The study indicates a preinstalled NPA in the right nasal passageway facilitates NGI in anesthetized and intubated patients as an initial NGI method and as a rescuing method for patients undergoing two unsuccessful initial attempts of NGI without a preinstalled NPA. However, the NPA method proved to take more time than the routine method for NGI successful at the first attempt. Trial registration: The study was conducted after receiving approval from Institutional Review Board of Chang Gung Memorial Hospital, Linkou branch, Taiwan (registration number 201800138A3; April 11, 2018), and the clinicaltrials.gov (NCT03697642; Principal Investigator: Ting-Yang Huang; Date of registration: October 4, 2018; https://www.clinicaltrials.gov/NCT03697642).

Ultrasound-Guided Central Venous Catheters in Elderly Patients with Cardiopulmonary Resuscitation

2020 ◽  
Vol 10 (12) ◽  
pp. 2970-2973
Author(s):  
Qing Xu ◽  
Feng Pan ◽  
Lei Qiao ◽  
Yu Wan
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Elderly Patients ◽  
Success Rate ◽  
The Elderly ◽  
Central Venous Catheters ◽  
Conventional Group ◽  
Central Vein ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Ultrasound Group

Objective: The elderly patients with cardiopulmonary resuscitation in intensive care unit (ICU), usually need timely and effective central vein catheterization to ensure the effective treatment. The aim of this study was to investigate the effect and safety of ultrasound-guided peripherally inserted central venous catheters (PICC) in elderly patients with cardiopulmonary resuscitation in ICU. Method: A total of 80 elderly patients with cardiopulmonary resuscitation from September 2016 to December 2019 were selected in Lu'An Hospital of Traditional Chinese Medicine. They were randomly divided into ultrasound group (40 cases) and conventional group (40 cases). The patients in conventional group were treated with conventional PICC, while the patients in ultrasound group were treated with ultrasound-guided PICC. The surgery, puncture success rate and complications were compared between ultrasound group and conventional group. Result: Ultrasound intervention showed the location of vessel at the puncture site and the whole process of catheter entry. Compared with the conventional group, the operation time, puncture time and intraoperative blood loss in ultrasound group was significantly less (P < 0.05). The success rate of once puncture in the ultrasound group was higher than that in conventional group (93% vs. 70%, P< 0.05). Compared with conventional group, the incidence of complications in ultrasound group was significantly lower than (P < 0.05). Conclusion: Compared with conventional PICC, ultrasound-guided PICC can provide better effect and reduce the incidence of complications for the elderly patients with cardiopulmonary resuscitation in ICU.

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