Comparison of Ease of Access of Spinal Anaesthesia by UltrasoundAssisted Versus Landmark Guided Technique among Anaesthesia Residents

Background: Spinal anaesthesia is one of the most commonly used regional anaesthetic techniques for lower abdominal, pelvic, and lower limb surgeries. Traditionally, the subarachnoid space is accessed using surface anatomical landmarks. However, this landmark-guided technique may be challenging in certain patients due to anatomical variations, obesity, or poorly palpable landmarks. Ultrasound imaging has recently been introduced as an adjunct to improve the identification of spinal anatomy and facilitate accurate needle placement. Ultrasound-assisted spinal anaesthesia may improve the ease of access to the subarachnoid space, particularly for anaesthesia residents who are still developing procedural skills. Aim: To compare the ease of access of the subarachnoid space using the ultrasound-assisted technique versus the landmark-guided technique among anaesthesia residents. Materials and Methods: This prospective randomized comparative study was carried out in the Department of Anaesthesiology and Critical Care at Sri Siddhartha Medical College and Hospital, Tumkur, Karnataka, India, over a period of 24 months. A total of 70 patients scheduled for surgeries requiring spinal anaesthesia were included in the study and randomly allocated using computer-generated randomization into two equal groups of 35 patients each. Group A (USG Group) consisted of 35 patients in whom spinal anaesthesia was administered using the ultrasound-assisted technique. Group B (LG Group) consisted of 35 patients in whom spinal anaesthesia was administered using the conventional landmark-guided technique. The procedures were performed by anaesthesia residents under supervision. Parameters assessed included number of attempts required to achieve successful dural puncture, time taken to access the subarachnoid space, first-attempt success rate, need for needle redirection, and overall ease of access as assessed by the performing resident. Data were analyzed using appropriate statistical tests, and a p-value of