Ultrasound-assisted subarachnoid block in obese parturient: Need of the hour

Subarachnoid block is commonly used for caesarean deliveries, by virtue of its simplicity in terms of performance and safety for the parturients when compared with general anesthesia. The landmark technique involves palpating the interspinous space at the level of Tuffier's line to ensure the interspace level and direct the spinal needle through optimally selected puncture site for performing the subarachnoid block. However, spinal block is sometimes not easy to perform in obese parturients primarily because of poorly palpable surface landmarks and challenges related to positioning for the block. Recently, ultrasound (USG) is being used for facilitating central neuraxial block, using low-frequency curvilinear probe with encouraging results. We report a case of a 28-year-old, 95-kg parturient, with body mass index of 39.1 kg/m2 scheduled for elective lower segment caesarean section under subarachnoid block, the indication being previous caesarean section. As the landmarks were not appreciable on palpation, we performed USG-assisted preprocedural landmark-based subarachnoid block successfully.