Study Compares Ultra-sonographic neuraxial target window of spine in Different Sitting Positions

Patient positioning is crucial for the successful administration of neuraxial blocks. Recently published study aimed to compare the ultrasonographic dimensions of the spine's acoustic target window in four different sitting positions, namely cross leg sitting (CLP), hamstring stretch (HSP), classical sitting (CSP), and rider's sitting position (RSP). The primary objective was to measure the neuraxial acoustic target window, specifically the interlaminar distance between L3-L4 lamina, while the secondary objective was to compare the depth of the ligamentum flavum from the skin, the diameter of the intrathecal space, and the comfort score in the different sitting positions.

The findings of the study revealed that there was no statistically significant difference in the interlaminar distance among the four sitting positions, with a mean interlaminar distance ranging from 1.40 cm to 1.44 cm. This suggests that all four positions are equally effective for spinal/epidural intervention. However, the classical sitting position (CSP) was identified as the most comfortable among the four positions, with a significantly better comfort score compared to the others. As a result, the study emphasized giving more importance to patient comfort during the procedure, as it can increase the success rate of the intervention.

The study also provided insights into the significance of patient positioning in the success of neuraxial blocks and highlighted the importance of ultrasonographic measurements for identifying various dimensions of the acoustic target window of the spine. Additionally, the study compared its findings with previous research and discussed the implications of the results in the context of the Indian population. The study acknowledged its limitations and recommended further research, particularly randomized control trials on the patient population, to provide additional evidence.

Summary and Implications -

In conclusion, the study found that all four sitting positions (CLP, HSP, CSP, RSP) are comparable in terms of the acoustic target window. However, the CSP was identified as the most comfortable position for the participants, indicating that patient comfort should be a crucial consideration in choosing a sitting position for neuraxial block procedures. The study's comprehensive analysis and comparison of the different positions provide valuable insights for practitioners and researchers in the field of neuraxial anesthesia.

Key Points -

- The study compared the ultrasonographic dimensions of the spine's acoustic target window in four different sitting positions: cross leg sitting (CLP), hamstring stretch (HSP), classical sitting (CSP), and rider's sitting position (RSP). The primary objective was to measure the neuraxial acoustic target window, specifically the interlaminar distance between L3-L4 lamina, while the secondary objective was to compare the depth of the ligamentum flavum from the skin, the diameter of the intrathecal space, and the comfort score in the different sitting positions.

- The findings revealed that there was no statistically significant difference in the interlaminar distance among the four sitting positions, suggesting that all four positions are equally effective for spinal/epidural intervention. However, the classical sitting position (CSP) was identified as the most comfortable among the four positions, with a significantly better comfort score compared to the others. The study emphasized the importance of patient comfort during the procedure, as it can increase the success rate of the intervention. Additionally, the study highlighted the significance of patient positioning in the success of neuraxial blocks and the importance of ultrasonographic measurements for identifying various dimensions of the acoustic target window of the spine.

- In conclusion, the study found that all four sitting positions (CLP, HSP, CSP, RSP) are comparable in terms of the acoustic target window. However, the CSP was identified as the most comfortable position for the participants, indicating that patient comfort should be a crucial consideration in choosing a sitting position for neuraxial block procedures. The study's comprehensive analysis and comparison of the different positions provide valuable insights for practitioners and researchers in the field of neuraxial anesthesia.

Reference –

Singh G, Sethi P, Kaur M, Bhatia P, Garg PK, Kumari K, et al. Comparison of neuraxial acoustic target window of the spine among rider sitting, cross leg, hamstring stretch, and classical sitting position:An observational study. J Anaesthesiol Clin Pharmacol 2024;40:318‑23.