The effect of ultrasonography marking on block success before neuraxial block in orthopedic lower extremity surgery patients over 65 years

Aim: Anatomic and physiological changes in geriatric patients make neuraxial blocks difficult. The traditional manual palpation is a blind technique and variations in patients' anatomies can reduce success of neuraxial block and lead to complications. As in peripheric blocks, using ultrasound can provide guidance. The aim of this study was to investigate effects of marking the place of spinal anesthesia under ultrasonography on success of neuraxial block in patients having surgery on lower extremities and aged over 65 years. Material and Methods: The study included 180 patients who were aged over 65 years and would have orthopedic surgery on their lower extremities under spinal anesthesia in Dokuz Eylül University Hospital. Out of 180 patients, 88 formed the ultrasound group and 92 formed the manual palpation group. The aim of this study was to compare the preprocedural ultrasound guided and manuel palpation marking groups in terms of successful spinal anesthesia procedure. Results: There was no significant difference in demographic features between the groups. The number of spinal anesthesia punctures and the number of needle redirections were significantly lower and duration of the spinal anesthesia procedure was significantly shorter in the ultrasound group (p<0,001). The rate of successful spinal anesthesia at one puncture was 73,9% in the ultrasound group and 44,6% in the manual palpation group with a significant difference (p<0,001). Conclusion: Marking the place of spinal anesthesia under ultrasonography increases success of the spinal anesthesia procedure, reduces the number of punctures and duration of the procedure, which decrease early complications. Key Words: orthopedia, neuraxial block, ultrasonography, spinal anesthesia, geriatrics.