ABSTRACT

Background and Objective: Anatomical and physiological changes in geriatric patients may make spinal anesthesia technically challenging. The traditional manual palpation technique is a blind approach, and anatomical variations may reduce block success and increase complications. Ultrasonography can provide guidance for spinal anesthesia. This study investigated the effect of preprocedural ultrasound-guided marking on block success in patients aged ≥65 years undergoing lower extremity orthopedic surgery.

Materials and Methods: This retrospective observational study included 180 patients aged ≥65 years who underwent lower extremity orthopedic surgery under spinal anesthesia at Dokuz Eylül University Hospital. Of these, 88 patients were in the ultrasound-guided marking group and 92 in the manual palpation group. The primary outcome was first-attempt success of spinal anesthesia. Secondary outcomes included puncture attempts, needle redirections, time to cerebrospinal fluid return, and spinal needle-placement time.

Results: Demographic characteristics were similar between the groups. The number of spinal punctures and needle redirections was significantly lower in the ultrasound group. In addition, spinal needle-placement time was significantly shorter in the ultrasound group (p < 0.001). Successful spinal anesthesia with a single puncture was achieved in 73.9% of patients in the ultrasound group and 44.6% in the manual palpation group (p < 0.001).

Conclusion: Preprocedural ultrasound-guided marking was associated with higher first-attempt success, fewer puncture attempts, fewer needle redirections, and shorter needle-placement time in elderly patients undergoing spinal anesthesia for lower extremity orthopedic surgery. Given the retrospective non-randomized design, these findings should be interpreted as an association rather than a definitive causal effect.