Hazal KOCA, Hale AKSU ERDOST, Semih KÜÇÜKGÜÇLÜ
Forbes Tıp Dergisi - 2026;7(1):75-83
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. Methods: This retrospective observational study included 180 patients aged >=65 years who underwent lower extremity orthopedic surgery under spinal anesthesia at Dokuz Eylül University Faculty of Medicine 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 return of cerebrospinal fluid, and spinal needle placement time. Results: Demographic characteristics were similar between the groups. The numbers of spinal punctures and needle redirections were 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 in 44.6% of patients 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.
