Comparison between two anatomic landmarks using ultrasonography in spinal anesthesia: a randomized controlled trial.

Area of Science:

• Anesthesiology
• Anatomy
• Medical Imaging

Background:

• Tuffier's line is a commonly used anatomical landmark in clinical practice.
• Accurate landmark identification is crucial for procedures like spinal anesthesia.

Purpose of the Study:

• To compare the accuracy of Tuffier's line with a novel landmark formed by the lowest points of the tenth ribs.
• To evaluate the utility of ultrasound in verifying landmark accuracy.

Main Methods:

• A prospective, randomized, double-blinded trial involving 200 adult patients (18-50 years).
• Exclusion criteria included extreme height or obesity (BMI >30 kg/m²).
• Landmarks (Tuffier's line vs. tenth rib line) for L4-5 were identified by an anesthesiologist and verified using ultrasound.

Main Results:

• No significant differences in demographic or surgical data between groups.
• The tenth rib line technique showed a significantly higher success rate (74%) compared to Tuffier's line (60%) for estimating the correct L4-5 level (p < 0.05).
• No correlation was found between estimation success and patient demographics.

Conclusions:

• The tenth rib line is a more accurate palpation landmark than Tuffier's line for L4-5 identification.
• Further research with multiple examiners and diverse populations is recommended to confirm these findings.