Imran Technique for Spinal Anesthesia and Lumbar Puncture (IMRAN-LP)

Imran's Approach: A Quasi-Experimental Prospective Comparative Study of an Alternative Positioning Technique for Spinal Anesthesia and Lumbar Puncture

This quasi-experimental prospective clinical trial was conducted to compare the conventional sitting position with the Imran Technique, a novel ergonomic patient-positioning method, for spinal anesthesia and lumbar puncture. A total of 200 adult participants requiring spinal anesthesia for surgical procedures or diagnostic lumbar puncture were allocated into two groups. The study aimed to evaluate procedural success, procedural efficiency, patient comfort, operator ergonomics, and procedure-related complications associated with the two positioning techniques.

Study Overview

• Status: Completed
• Conditions: Spinal Anesthesia; Lumbar Puncture; Patient Positioning
• Intervention / Treatment: Procedure: Conventional Sitting Position; Procedure: Imran Technique

Detailed Description

This quasi-experimental prospective clinical trial was designed to compare the conventional sitting position and the Imran Technique during spinal anesthesia and lumbar puncture procedures. Adult participants aged 18 to 65 years who required spinal anesthesia for surgical procedures or diagnostic lumbar puncture were enrolled and allocated into two groups.

Participants in the control group underwent the procedure using the conventional sitting position, while participants in the intervention group underwent the procedure using the Imran Technique. The primary outcome measure was first-attempt procedural success. Secondary outcome measures included total procedural time, positioning-to-needle insertion time, number of needle attempts, needle redirections, intervertebral space changes, overall procedural success, need for operator assistance, patient comfort, ability to maintain position, operator strain, accessibility of the intervertebral space, and procedure-related complications.

The study was conducted at the Intensive Care Unit of the Department of Anaesthesiology, POF Hospital, Wah Cantt, Pakistan, following Institutional Review Board approval and written informed consent procedures.

• Study Type: Interventional
• Enrollment (Actual): 200
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Wah, Punjab Province, Pakistan, 4070
      • Wah Medical College, POF Hospital Wah cantt

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Adult participants aged 18 to 65 years
• Participants requiring spinal anesthesia for surgical procedures or diagnostic lumbar puncture
• Participants medically suitable for spinal anesthesia or lumbar puncture
• Participants able to assume and maintain the assigned procedural position
• Participants who provided written informed consent

Exclusion Criteria:

• Age below 18 years or above 65 years
• Previous spinal surgery
• Significant spinal deformity
• Local infection at the puncture site
• Coagulopathy or bleeding disorders
• Raised intracranial pressure
• Severe hemodynamic instability
• Inability to maintain the assigned procedural position
• Refusal to participate or inability to provide informed consent

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Conventional Sitting Position; Participants underwent spinal anesthesia or lumbar puncture using the conventional sitting position according to standard institutional practice.	Procedure: Conventional Sitting Position; Standard sitting patient positioning used for spinal anesthesia and lumbar puncture procedures.
Experimental: Imran Technique; Participants underwent spinal anesthesia or lumbar puncture using the Imran Technique, a novel ergonomic positioning method designed to improve lumbar flexion, operator ergonomics, and procedural access.	Procedure: Imran Technique; A novel ergonomic patient positioning technique for spinal anesthesia and lumbar puncture involving lateral operator positioning and assisted lumbar flexion to improve procedural access and success.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
First Attempt Procedural Success	Successful spinal anesthesia or lumbar puncture achieved with a single skin puncture on the first attempt.	During the procedure (up to 30 minutes)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Procedural Time	Total time required from patient positioning to successful completion of spinal anesthesia or lumbar puncture.	During the procedure (up to 30 minutes)
Number of Needle Attempts	Total number of skin puncture attempts required to successfully complete the procedure.	During the procedure
Needle Redirections	Number of needle redirections required during spinal anesthesia or lumbar puncture.	During the procedure
Intervertebral Space Changes	Number of intervertebral space changes required to successfully complete the procedure.	During the procedure
Overall Procedural Success	Successful completion of spinal anesthesia or lumbar puncture regardless of the number of attempts required.	During the procedure (up to 30 minutes)
Patient Comfort Assessed Using a 0-10 Numeric Rating Scale (NRS)	Participant comfort during positioning and spinal anesthesia/lumbar puncture was assessed using a 0-10 Numeric Rating Scale, where lower scores indicate greater comfort.	During the procedure
Ability to Maintain Position Assessed Using an Investigator-Defined 3-Category Scale	Participant ability to maintain the assigned procedural position was assessed using an investigator-defined 3-category scale: Easy, Moderate, or Difficult.	During the procedure
Operator Strain Assessed Using an Investigator-Defined 4-Category Ergonomic Scale	Operator physical strain during the procedure was assessed using an investigator-defined 4-category scale: None, Mild, Moderate, or Severe.	During the procedure
Accessibility of Intervertebral Space Assessed Using an Investigator-Defined 3-Category Operator Rating Scale	Accessibility of the intervertebral space was assessed by the operator using an investigator-defined 3-category scale: Easy, Acceptable, or Difficult.	During the procedure
Procedure-Related Complications	Occurrence of procedure-related events including paresthesia, bloody tap, hypotension, bradycardia, or procedural failure.	uring the procedure and immediately after procedure (up to 1 hour)

Collaborators and Investigators

• Sponsor: Wah Medical college , POF hospital
• Investigators: Principal Investigator: Imran Ul Haq, MBBS, FCPS, Wah Medical College (NUMS) / POF Hospital Wah Cantt, Pakistan

Study record dates

Study Major Dates

• Study Start (Actual): March 2, 2026
• Primary Completion (Actual): March 31, 2026
• Study Completion (Actual): March 31, 2026

Study Registration Dates

• First Submitted: May 27, 2026
• First Submitted That Met QC Criteria: June 3, 2026
• First Posted (Actual): June 4, 2026

Study Record Updates

• Last Update Posted (Actual): June 4, 2026
• Last Update Submitted That Met QC Criteria: June 3, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Ergonomics; Spinal Anesthesia; Lumbar Puncture; Procedural Success; Patient Positioning; Imran Technique; Anesthesia Technique
• Other Study ID Numbers: WMC-IRB-157-2026; IRB Approval Number (Other Identifier: WMC/ERC/IRB/157)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Individual participant data that underlie the results reported in the published article, after de-identification.
• IPD Sharing Time Frame: Beginning 1 year after publication
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No