Landmark-guided versus Real-time Ultrasound-guided Combined Spinal-epidural Anesthesia Techniques: Paramedian Sagittal Oblique and Transverse Interlaminar Approach

Abstract Background: There are different types of real-time ultrasound (US)-guided combined spinal epidural (CSE) anesthesia techniques. We aimed to investigate the effect of real-time US-guided paramedian sagittal oblique (PSO), transverse interlaminar (TI) approach method, and landmark-guided (LG) CSE anesthesia. Methods: Ninety patients who underwent CSE block were included in the study. Patients were randomized into LG ( n = 30), PSO ( n = 30), and TI ( n = 30) groups. The primary outcome was number of needle manipulations. The secondary outcomes are the number of attempts, needle visibility, procedure time, procedure success rate, catheter placement difficulty, posterior complex distance, and complications. Results: The number of needle manipulations was statistically significantly lower in the LG technique group ( P < 0.000). When the number of attempts, the difficulty of catheter placement, and the procedure’s success rate were compared between the three groups, we did not find a statistically significant difference ( P > 0.05). In addition, when the procedure times were compared, the time measured for the LG group was statistically significantly lower than in the PSO and TI groups ( P < 0.000). Conclusion: In the results of this study, the real-time US-guided CSE anesthesia application had a similar success and complication level with LG technique. The LG method had a shorter processing time and fewer needle manipulations.