{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:32:05Z","timestamp":1791869525396,"version":"4.3.4"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2025,3,1]],"date-time":"2025-03-01T00:00:00Z","timestamp":1740787200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,3]]},"abstract":"\n Background:<\/jats:title>\n It is a great challenge to perform regional anesthesia in obese patients. In general, combined spinal epidural (CSE) anesthesia is performed blindly using the surface landmark of the midline approach. Obesity masks the surface landmark and makes the procedure difficult.<\/jats:p>\n <\/jats:sec>\n \n Aim:<\/jats:title>\n This study aimed to compare the efficacy and ease of the real-time ultrasound (USG)-guided CSE (RUC) and preprocedure USG-guided CSE (PUC) approach in obese patients.<\/jats:p>\n <\/jats:sec>\n \n Settings and Design:<\/jats:title>\n This prospective randomized intervention study was conducted at a tertiary care center.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Eighty patients with the American Society of Anaesthesiologists Grade II and III and a body mass index >30 kg.m\n \u2212<\/jats:sup>\n 2<\/jats:sup>\n were included in the study, and randomly, they were assigned into two groups: PUC and RUC groups. The main focus of the study was on the initial effort to position an epidural catheter and administer a subarachnoid block effectively. The secondary outcomes included the number of attempts, the number of passes made, the time needed to identify the epidural space (measured in seconds), and the time it took to place the epidural catheter (measured in seconds) successfully.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Out of 80 patients, 77 patients were randomly allocated between two groups for the final analysis. The PUC group received 39, and the RUC group received 38 patients. The median number of attempts was 4 [interquartile range (IQR) 2\u20134] and 2 (IQR 1\u20132), respectively, in the PUC and RUC groups (\n P<\/jats:italic>\n < 0.001). Compared to the PUC group, the RUC group showed a statistically significant reduction in the median number of passes, the time taken for space identification, and the time required for successful epidural catheter placement.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n In the comparison between the PUC and RUC groups, the PUC group demonstrated significantly longer durations for space identification, required more attempts, had a greater number of passes, and exhibited a prolonged time for successful epidural catheter placement.<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/njcp.njcp_371_24","type":"journal-article","created":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T08:00:19Z","timestamp":1744358419000},"page":"273-279","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparative Study of Preprocedure and Real-Time Ultrasound-guided Combined Spinal Epidural Anesthesia in Obese Patients"],"prefix":"10.4103","volume":"28","author":[{"given":"R","family":"Anand","sequence":"first","affiliation":[{"name":"Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GK","family":"Ram","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Narayan Medical College and Hospital, Sasaram, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Aman","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Naskar","sequence":"additional","affiliation":[{"name":"Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,4,11]]},"reference":[{"key":"R1-20260423","doi-asserted-by":"crossref","first-page":"106.","DOI":"10.1186\/s40001-021-00577-9","article-title":"Comparison of different approaches to combined spinal epidural anesthesia (CSEA) under the guidance of ultrasound in cesarean delivery of obese patients: A randomized controlled trial","volume":"26","author":"Zhou","year":"2021","journal-title":"Eur J Med Res"},{"key":"R2-20260423","doi-asserted-by":"crossref","first-page":"248.","DOI":"10.1186\/s12871-020-01172-x","article-title":"Preprocedural ultrasound guidance for combined spinal-epidural anaesthesia results in better success rates in elderly patients with hip fracture: A randomized controlled trial","volume":"20","author":"Qu","year":"2020","journal-title":"BMC Anesthesiol"},{"key":"R3-20260423","first-page":"140","article-title":"Comparing between ultrasound assisted epidural catheter placement using Accuro and the use of ultrasound real time with acoustic puncture-assisted device to confirm epidural space end point","volume":"36","author":"Mohamed","year":"2021","journal-title":"Egypt J Anaesth"},{"key":"R4-20260423","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4103\/ija.IJA_488_17","article-title":"Comparison of landmark versus pre-procedural ultrasonography- assisted midline approach for identification of subarachnoid space in elective caeserean section: A randomised controlled trial","volume":"62","author":"Dhanger","year":"2018","journal-title":"Indian J Anaesth"},{"key":"R5-20260423","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1093\/bja\/aex108","article-title":"Real-time ultrasound paramedian spinal anaesthesia: Evaluation of the efficacy and the success rate of single needle pass","volume":"118","author":"Chong","year":"2017","journal-title":"Br J Anaesth"},{"key":"R6-20260423","first-page":"525818.","article-title":"Real-time ultrasound-guided spinal anaesthesia: A prospective observational study of a new approach","volume":"2013","author":"Conroy","year":"2013","journal-title":"Anesthesiol Res Pract"},{"key":"R7-20260423","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1007\/s12630-013-9984-9","article-title":"Single-operator real-time ultrasound-guided spinal injection using SonixGPS\u2122: A case 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technique","volume":"102","author":"Karmakar","year":"2009","journal-title":"Br J Anaesth"},{"key":"R11-20260423","first-page":"573","article-title":"Real-time ultrasound-guided spinal anaesthesia using Sonix GPS ultrasound guidance system; A feasibility study","volume":"71","author":"Niazi","year":"2016","journal-title":"Acta Anaesthesiol Scand"},{"key":"R12-20260423","doi-asserted-by":"crossref","first-page":"53","DOI":"10.4103\/ija.IJA_448_17","article-title":"Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5-S1: Is this better than landmark-guided midline approach? A randomised controlled trial","volume":"62","author":"Srinivasan","year":"2018","journal-title":"Indian J Anaesth"},{"key":"R13-20260423","doi-asserted-by":"crossref","first-page":"377","DOI":"10.4103\/0019-5049.183398","article-title":"Comparison of ultrasound imaging in transverse median and parasagital oblique planes for thoracic epidurals: A pilot study","volume":"60","author":"Khemka","year":"2016","journal-title":"Indian J Anaesth"},{"key":"R14-20260423","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1007\/s00586-011-2029-6","article-title":"Spinous process morphology: The effect of ageing through adulthood on spinous process size and relationship to sagittal alignment","volume":"21","author":"Aylott","year":"2012","journal-title":"Eur Spine J"},{"key":"R15-20260423","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ijoa.2016.07.007","article-title":"Ultrasound to identify the lumbar space in women with impalpable bony landmarks presenting for elective caesarean delivery under spinal anaesthesia: A randomised trial","volume":"28","author":"Creaney","year":"2016","journal-title":"Int J Obstet Anesth"},{"key":"R16-20260423","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s12630-010-9337-x","article-title":"The use of ultrasound for lumbar spinous process identification: A pilot study","volume":"57","author":"Halpern","year":"2010","journal-title":"Can J Anesth"},{"key":"R17-20260423","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s12630-009-9252-1","article-title":"Single-operator real-time ultrasound-guidance to aim and insert a lumbar epidural needle","volume":"57","author":"Tran","year":"2010","journal-title":"Can J Anaesth"}],"container-title":["Nigerian Journal of Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_371_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:01:24Z","timestamp":1786647684000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/njcp.njcp_371_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":17,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/njcp.njcp_371_24","relation":{},"ISSN":["1119-3077","2229-7731"],"issn-type":[{"value":"1119-3077","type":"print"},{"value":"2229-7731","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]},"assertion":[{"value":"2024-06-02","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-02","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}