ArticleIndian journal of anaesthesia2026
Ultrasound-guided measurement of cross-sectional area of dural sac to titrate the dosage of local anaesthetic in geriatric orthopaedic surgery under spinal anaesthesia: A prospective randomised study.
Article in Indian journal of anaesthesia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: Dural sac cross-sectional area (DSCSA)-based intrathecal dosing aims to optimise block spread and improve haemodynamic stability during spinal anaesthesia (SA). Ultrasound-guided DSCSA measurement helps in local anaesthetic (LA) dose reduction compared with conventional fixed-dose practice. The primary objective was to determine LA dosage proportional to DSCSA reduction, while the secondary objectives included comparison of block characteristics and intra-operative haemodynamic parameters [heart rate and mean arterial pressure (HR and MAP)] between the two approaches. Methods: This prospective randomised study included 60 American Society of Anesthesiologists I-III patients aged >65 years undergoing orthopaedic surgery under SA. Patients were allocated to an ultrasound-guided DSCSA-based dosing group (US, Results: Group US had a mean dural sac diameter of 11.99 (0.76) mm and a DSCSA of 112.98 (13.42) mm², resulting in a mean calculated dose of 1.79 (0.14) mL. Both groups achieved a maximum motor block score of 3. Group C showed significantly greater reductions in HR, with more frequent bradycardia, and a significant decrease in MAP between 10 and 30 minutes. Surgical duration was comparable between the groups. Conclusion: Ultrasound-guided DSCSA-based dosing improves haemodynamic stability and reduces bradycardia and hypotension while maintaining comparable block quality to conventional fixed-dose SA.
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