Real-Time Ultrasound–Guided Versus Ultrasound-Assisted Spinal Anesthesia in Elderly Patients With Hip Fractures: A Randomized Controlled Trial

BACKGROUND: Traditional landmark-guided spinal anesthesia can be challenging in elderly patients with hip fractures. Ultrasound assistance (US AS ) and real-time ultrasound guidance (US RTG ) techniques can facilitate lumbar neuraxial blocks. However, it remains undetermined which method is optimal for use in elderly patients. This study aimed to evaluate which technique was associated with a higher success rate of spinal anesthesia in elderly patients with hip fractures: US AS or US RTG technique. METHODS: A total of 114 elderly patients (≥70 years of age) with hip fractures were randomly assigned to receive spinal anesthesia using either the US AS or US RTG technique. The primary outcome was the first-attempt success rate, analyzed using the χ 2 test. Secondary outcomes included first-pass success rate, the number of needle attempts and passes, locating time, procedure time, total time, adverse reactions and complications, patient satisfaction, and procedural difficulty score. RESULTS: The first-attempt success rate (80.7% vs 52.6%; 95% confidence interval [CI], for the difference, 11.6–44.6) and first-pass success rate (63.2% vs 31.6%; 95% CI for the difference, 14.2–49) were both significantly higher in the US AS compared with the US RTG group (both P = .001). The number of attempts (1 [1–1] vs 1 [1–3]; P = .001) and median passes (1 vs 3; P < .001) were both significantly lower in the US AS group than in the US RTG group. The US RTG group had a shorter locating time (175 seconds [129–234 seconds] vs 315 seconds [250–390 seconds]; P < .001) but a longer procedure time (488 seconds [260–972 seconds] vs 200 seconds [127–328 seconds]; P < .001) and total time (694 seconds [421–1133 seconds] vs 540 seconds [432–641 seconds]; P = .036). There were no significant differences between the 2 groups with regard to the adverse reactions and complications. More patients in the US AS group had a high satisfaction score of 3 to 5 ( P = .008). Overall, anesthesiologists rated the US RTG group procedure as “more difficult” ( P = .008). CONCLUSIONS: In elderly patients with hip fractures, spinal anesthesia with the US RTG technique is not superior to the US AS technique since it has a lower success rate, longer procedure time, lower satisfaction score, and is more difficult to perform. So US AS technique may be more suitable for elderly patients.