To investigate the efficiency of the ultrasonic-assisted positioning technique for lumbar anesthesia in elderly patients with hip fractures through the paramedian approach compared with body surface labeling.

Patients(aged ≥65 years)with hip fractures were randomized(1∶1)to receive either ultrasound-assisted or landmark-guided paramedian spinal anesthesia in a lateral position.The primary outcome was the number of needle passes needed for a successful dural puncture.The secondary outcomes included one-pass success rate, number of needle attempts, one-attempt success rate, total time of spinal anesthesia and adverse effects.

A total of 88 subjects were randomized.The ultrasound-assisted approach significantly reduced the number of needle passes, compared with the landmark-guided approach[2.0(1.0-3.0) vs.5.0(3.0-8.8); Z=-4.708, P<0.001]. The one-pass success rate was higher in the ultrasound-assisted approach than in the landmark-guided approach[40.9%(18/44) vs.4.5%(2/44); χ²=16.565, P<0.001]. There was no statistical difference in the number of needle attempts and one-attempt success rate between the two groups(P>0.05 for both). The total time of spinal anesthesia was longer in the ultrasound-assisted group than in the landmark-guided group[252(218-317) s vs.168(143-195) s; Z=-5.592, P<0.001]. In the ultrasound-assisted group, fewer patients developed bloody cerebral spinal fluid taps than in the landmark-guided group[0%(0/44) vs.18.2%(8/44); χ²=6.738, P=0.009].

In elderly hip fracture patients, ultrasound-assisted paramedian spinal anesthesia is superior to the landmark-guided approach in reducing the number of needle passes and should be recommended for these patients.

Hip fractures; Sonication; Intravertebral anesthesia