Comparing Ultrasound Guided Midline and Landmark Paramedian Techniques for Continuous Spinal Anesthesia in Elderly Patients with Hip Fractures

What this Trial Is About

Researchers are comparing two techniques for continuous spinal anesthesia in elderly patients undergoing surgery for hip fractures. This study evaluates the traditional landmark guided paramedian approach against a newer ultrasound guided midline approach. The goal is to determine which method is safer and more effective for spinal anesthesia in this population, building on previous studies suggesting benefits of ultrasound guidance. Participants, all aged 65 and older, will be randomly assigned to one of two groups. One group will receive the conventional landmark guided paramedian continuous spinal anesthesia, where the injection site is identified by palpation. The other group will have the ultrasound guided midline continuous spinal anesthesia, where ultrasound imaging is used to identify the best injection site and needle angle. Both groups will receive a fascia-iliaca block before the spinal anesthesia and will be monitored closely during the procedure. During the study, patients will undergo baseline monitoring and receive standardized anesthesia preparations. Researchers will record the number of needle passes and attempts, the success rate on first try, the time to identify landmarks, and the duration of the spinal anesthesia procedure. Ultrasound images will be reviewed, and any complications will be documented. The primary outcome is the difference in needle passes between groups. Participation involves surgery and anesthesia care with detailed monitoring until catheter removal, with the study expected to last until August 2025.

Ultrasound Guided Midline vs Landmark Paramedian Continous Spinal Anesthesia in the Elderly