Landmark Versus Ultrasongraphy Guided Spinal Anesthesia in Lower Abdominal Surgeries in Cancer Patients: a Randomized Controlled Trial

The traditional landmark method relies on palpating anatomical structures, such as the iliac crests and spinal processes, to guide needle insertion. Although widely used, it can be challenging in patients with anatomical variations, obesity, or previous surgeries, potentially leading to multiple attempts, increased patient discomfort, or complications. On the other hand, Ultrasound (US) imaging has become an increasingly popular tool among anesthesiologists to guide neuraxial blockade. US-guided spinal anesthesia provides real-time visualization of the relevant anatomy, including the spinal canal, ligaments, and surrounding tissues, enabling more accurate needle placement. This technique has gained attention for its potential to improve success rates, reduce complications, and enhance patient comfort, particularly in complex cases such as cancer patients, where precision is vital.

By examining factors such as procedural success rates, patient comfort, complication rates, and overall outcomes, we can better understand the role of ultrasound guidance in optimizing anesthetic care for this vulnerable patient population.

Inclusion criteria

• Age >18 years old
• Both sex
• patients with a body mass index (BMI) of 18-40 kg/m2
• American Society of Anesthesiologists (ASA) physical status classification of I to III.

Exclusion criteria

• • Patients have a contraindication for regional anesthesia, e.g. coagulopathy.

• Failed or unsatisfactory intrathecal block.
• Patients with known hypersensitivity to amide local anesthetics.
• Local injection site infection or spinal deformity.
• Severe hypotension.
• Space occupying lesions of the brain.
• Hypovolemia.
• Pregnancy.