Dataset Information

The 'Cross-Legged Foetal Sitting Neuraxial Position': Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography.

ABSTRACT: Objective:The primary aim of the present study was to compare the 'cross-legged foetal sitting position' (CFSP) with the 'sitting foetal position' (SFP) sonographically. The secondary aim was to compare their comfort. Methods:A randomised, consecutive controlled, single-blinded trial was performed in Yeditepe University. A total of 50 healthy volunteers were included in the study. Exclusion criteria were body mass index (BMI) >40 kg m-2, lumbar hernia, scoliosis, history of spine surgery, lower back pain or trauma, especially pelvic or knee problems related to arthropathy and not able to do one/both of the two position techniques. The two positioning techniques were evaluated by ultrasonography (USG) and 5-point Numerical Rating Scale (5-NRS) patient satisfaction of comfort questionnaire. Seven outcomes via USG were evaluated, subcutaneous tissue (ST), skin to spinous process (S-SP), transverse diameters of right and left paraspinal muscles (RPM and LPM), interspinous gap opening (ISGO), mean of bilateral paraspinal muscle (MPM) and CFSP-SFP change (CFSP-SFP). Stretcher comfort, position comfort, lumbar comfort (LC) and abdominal comfort (AC) were evaluated by participants with the 5-NRS. Results:In the CFSP, the mean ST and S-SP were significantly (p<0.0001) shorter, and LPM, RPM and MPM were significantly (p<0.0001) wider. The mean ISGO in the CFSP was significantly (p<0.0001) broader. The CFSP was significantly more comfortable than the SFP according to the LC (p=0.02). Only ISGO was found to be significantly broader in the male participant group (p=0.01) and in the BMI ?25 group (p=0.02) according to CFSP-SFP. Conclusion:Considering all ultrasonographic anatomical measurements and according to the 5-NRS related to LC, the CFSP appears to be more advantageous than the SFP as a neuraxial positioning technique.

SUBMITTER: Kartufan FF

PROVIDER: S-EPMC7556637 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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The 'Cross-Legged Foetal Sitting Neuraxial Position': Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography.

Kartufan Fatma Ferda FF Karatay Emrah E Kızılcık Nurcan N Köner Özge Ö

Turkish journal of anaesthesiology and reanimation 20191226 5

<h4>Objective</h4>The primary aim of the present study was to compare the 'cross-legged foetal sitting position' (CFSP) with the 'sitting foetal position' (SFP) sonographically. The secondary aim was to compare their comfort.<h4>Methods</h4>A randomised, consecutive controlled, single-blinded trial was performed in Yeditepe University. A total of 50 healthy volunteers were included in the study. Exclusion criteria were body mass index (BMI) >40 kg m-2, lumbar hernia, scoliosis, history of spine ...[more]

PMID: 33103141

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Project description:BACKGROUND:The patient's position during spinal anesthesia administration plays a major role in the success of spinal needle insertion into the subarachnoid space. The traditional sitting position (TSP) is the standard position for spinal anesthesia administration, but the success rate for spinal anesthesia administration in the TSP is still quite low. The crossed-leg sitting position (CLSP) is one of the alternative positions for the administration of spinal anesthesia, which can increase the degree of lumbar flexion. OBJECTIVES:This study aimed to compare successful spinal needle placement to patients in the CLSP and patients in the TSP prior to undergoing urology surgery. METHODS:This study was a non-blinded, randomized controlled trial in patients undergoing spinal anesthesia for urologic procedures from March-October, 2015 in the central national hospital Dr. Cipto Mangunkusumo, Indonesia. After obtaining approval from the FMUI - RSCM (Faculty of Medicine Universitas Indonesia - Rumah Sakit Dr. Cipto Mangunkusumo) Ethical Committee and informed consent from patients, 211 subjects were allocated into two groups: the CLSP group (n = 105) and the TSP group (n = 106). The proportion of successful spinal needle placement to the subarachnoid space, ease of landmark palpation, and the number of needle-bone contacts in both groups were then assessed and analyzed. RESULTS:The rate of first-time successful spinal needle insertion was not significantly different between the CLSP and TSP groups (62.9% versus 55.7%, P > 0.05). Ease of landmark palpation in the CLSP group was not significantly different from that in the TSP group (86.7% versus 76.4%, P > 0.05). The number of needle-bone contacts in both groups were not significantly different (P > 0.05). The complication rates were similar in both groups. CONCLUSIONS:The rate of successful spinal needle placement in the CLSP group was not significantly different from that in the TSP group in patients undergoing urology surgery. The CLSP can be used as an alternative sitting position for administration of spinal anesthesia.

Project description:BackgroundPositioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥ 30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke.Methods/designWe plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥ 30°) head position as a 'business as usual' stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period.DiscussionHeadPoST is a large international clinical trial in which we will rigorously evaluate the effects of different head positioning in patients with acute stroke.Trial registrationClinicalTrials.gov identifier: NCT02162017 (date of registration: 27 April 2014); ANZCTR identifier: ACTRN12614000483651 (date of registration: 9 May 2014). Protocol version and date: version 2.2, 19 June 2014.

Project description:BackgroundPrevious studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT.Methodology/principal findingsWe performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p<0.05). Despite this reduction, we observed a greater frequency of poor CSA outcomes in the MB compared to the PB (77.8% and 40.6%; p>0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; p<0.05). There was significantly higher odds ratio (7.75; 95%CI: 1.56-38.45) for poor CSA outcomes only for M nerve in patients with reactions. Poor echogenicity outcomes were more frequent in MB (59.4%) compared to PB (22.2%) (p<0.05). There was significant association between poor Doppler outcomes and neuritis. Gender, disease duration, and leprosy classification were not significant risk factors for poor outcomes in CSA, echogenicity or Doppler.Conclusions/significanceUS nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.

Project description:BackgroundTotal hip arthroplasty (THA) instability is influenced by acetabular component positioning, spinopelvic function and sagittal spinal alignment. Obesity is considered as a risk factor of THA instability, but the causal relationship remains unknown. This study aimed to investigate the influence of BMI on (1) spinopelvic function (lumbar flexibility, pelvic mobility and hip motion), (2) sagittal spinal alignment pre- and postoperatively and (3) acetabular cup position postoperatively in primary THA patients in a prospective setting.MethodsOne hundred ninety patients receiving primary total hip arthroplasty were enrolled in a prospective cohort study and retrospectively analysed. All patients received stereoradiography (EOS) in standing and relaxed sitting position pre-and postoperatively. C7-sagittal vertical axis (C7-SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), anterior plane pelvic tilt (APPT), and pelvic femoral angle (PFA) were assessed. Key parameters of the spinopelvic function were defined as lumbar flexibility (∆ LL = LLstanding - LLsitting), pelvic mobility (∆ PT = PTstanding - PTsitting) and hip motion (∆ PFA = PFAstanding - PFAsitting). Pelvic mobility was further defined based on ∆ PT as stiff, normal and hypermobile (∆ PT < 10°; 10°-30°; > 30°). The patients were stratified to BMI according to WHO definition: normal BMI ≥ 18.5-24.9 kg/m2 (n = 68), overweight ≥ 25.0-29.9 kg/m2 (n = 81) and obese ≥ 30-39.9 kg/m2 (n = 41). Post-hoc analysis according to Hochberg's GT2 was applied to determine differences between BMI groups.ResultsStanding cup inclination was significant higher in the obese group compared to the normal BMI group (45.3° vs. 40.1°; p = 0.015) whereas standing cup anteversion was significantly decreased (22.0° vs. 25.3°; p = 0.011). There were no significant differences for spinopelvic function key parameter lumbar flexibility (∆ LL), pelvic mobility (∆ PT) and hip motion (∆ PFA) in relation to BMI stratified groups. The obese group demonstrated significant enhanced pelvic retroversion compared to the normal BMI group (APPT - 1.8° vs. 2.4°; p = 0.028). The preoperative proportion of stiff pelvic mobility was decreased in the obese group (12.2%) compared to normal (25.0%) and overweight (27.2%) groups. Spinal sagittal alignment in C7-SVA and PI-LL mismatch demonstrated significantly greater imbalance in the obese group compared to the normal BMI group (68.6 mm vs. 42.6 mm, p = 0.002 and 7.7° vs. 1.2°, p = 0.032, respectively) The proportion of patients with imbalanced C7-SVA was higher in the obese (58.5%) than in the normal BMI group (44.1%).ConclusionsThe significantly increased spinal sagittal imbalance with altered pelvic mechanics is a potential cause for the reported increased risk of THA dislocations in obese patients. Consequently, the increased spinal sagittal imbalance in combination with normal pelvic mobility need to be taken into account when performing THA in obese patients.

Dataset Information

The 'Cross-Legged Foetal Sitting Neuraxial Position': Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography.

Publications

The 'Cross-Legged Foetal Sitting Neuraxial Position': Is it Beneficial?-A Prospective Randomised Clinical Trial Via Ultrasonography.

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