A Comparison between Median and Paramedian Technique of Giving Spinal Anaesthesia in Elderly Patients Undergoing Elective Lower Abdominal and Lower Extremity Procedures
Authors/Creators
- 1. Professor and HOD, Department of Anaesthesiology, ST. Johns Medical College and Hospital, Bangalore
- 2. MBBS, DA, DNB Anaesthesiology, IDCCM Assistant Professor, Department of Anaesthesiology, Critical Care and Pain, Dr. B. Borooah Cancer Institute, Guwahati, Assam
Description
Introduction: Spinal anaesthesia is difficult in the elderly because of the age related physiological changes of the spinal anatomy and difficult positioning by the classical midline approach. The paramedian approach, although not widely used, can overcome these difficulties. The study was done to compare the technical ease in performing spinal anaesthesia between these two approaches in the elderly. Materials and Methods: This prospective randomised double blinded study was done in elderly patients of age more than 65 years undergoing lower abdominal and lower extremity surgeries. Successful puncture at first attempt, Number of attempts, Redirections of the needle, Duration of the procedure, Failures and Incidence of paraesthesia and backache were noted. 60 patients were randomized into two groups of 30 each : Group M: Patients received spinal anaesthesia by Median approach. Group PM: Patients received spinal anaesthesia by Paramedian approach. Results: The success rate at the first puncture was much high in the paramedian group compared to the median group. (p=0.015). Number of fresh needle attempts, needle redirections and failures were significantly less in paramedian group compared to median group.(p<0.001), (p=0.005), (p<0.001) respectively. No difference was found in the incidence of paresthesia in the two groups. The incidence of backache was more in the median group in the immediate postoperative period. (p<0.001). Conclusion: Paramedian approach has more success rate, less technical difficulties and more patient comfort than the median approach in elderly patients and it should be considered as the preferred initial approach of giving spinal anaesthesia in the elderly.
Abstract (English)
Introduction: Spinal anaesthesia is difficult in the elderly because of the age related physiological changes of the spinal anatomy and difficult positioning by the classical midline approach. The paramedian approach, although not widely used, can overcome these difficulties. The study was done to compare the technical ease in performing spinal anaesthesia between these two approaches in the elderly. Materials and Methods: This prospective randomised double blinded study was done in elderly patients of age more than 65 years undergoing lower abdominal and lower extremity surgeries. Successful puncture at first attempt, Number of attempts, Redirections of the needle, Duration of the procedure, Failures and Incidence of paraesthesia and backache were noted. 60 patients were randomized into two groups of 30 each : Group M: Patients received spinal anaesthesia by Median approach. Group PM: Patients received spinal anaesthesia by Paramedian approach. Results: The success rate at the first puncture was much high in the paramedian group compared to the median group. (p=0.015). Number of fresh needle attempts, needle redirections and failures were significantly less in paramedian group compared to median group.(p<0.001), (p=0.005), (p<0.001) respectively. No difference was found in the incidence of paresthesia in the two groups. The incidence of backache was more in the median group in the immediate postoperative period. (p<0.001). Conclusion: Paramedian approach has more success rate, less technical difficulties and more patient comfort than the median approach in elderly patients and it should be considered as the preferred initial approach of giving spinal anaesthesia in the elderly.
Files
IJPCR,Vol14,Issue12,Article39.pdf
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Additional details
Dates
- Accepted
-
2022-12-11
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue12,Article39.pdf
- Development Status
- Active
References
- 1. Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004;21 (14):895-910. 2. Ahsan-ul-Haq M, Amin S, Javaid S. Paramedian technique of spinal anesthesia in elderly patients for hip fracture surgery. J Coll Physicians Surg Pak. 2005 Mar;15(3):160-1. 3. Shehzad F., Haider S. Z., Zafar B., Malik H., Jahangir M. A., & Kirwan S. Comparison of Paramedian with Midline Technique of Spinal Anaesthesia in Elderly. PAFMJ. 2018; 68(5), 1168-72 4. Bano N, Hayat N, Saleem S, Javed F, Rehman A, Mahmood K. Comparative study of midline versus paramedian approach of spinal block in elderly. Professional Med J 2021; 28(11):1664- 1667. 5. Bapat V, Vishwasrao S. Spinal anaesthesia with midline and paramedian technique in elderly patients. Indian journal of applied research. 2015; 5(9):442-444.14 6. Kartal Seyfi & Kongur, Esra. Evaluation Of the Median and Paramedian Approach in Spinal Anesthesia in Elderly Patients. Dicle Tıp Dergisi. 2020;47: 243-249. 7. Rabinowitz A, Bourdet B, Minville V, Chassery C, Pianezza A, Colombani A, et al. The paramedian technique: a superior initial approach to continuous spinal anesthesia in the elderly. Anesth Analg. 2007;105(18042894):1855-7 8. T. Zhurda MK, M. Bajraktari, D. Muzha, B. Kurti. The advantages of paramedian approach for spinal anesthesia of elderly patients in urology surgery. European Journal of Anaesthesiology. 2010;27(47):130 9. 9. Muranaka K, Mizutani H, Seo K, Yoshida M, Gohara T, Miyawaki H. [A comparison between midline and paramedian approaches for combined spinal-epidural anesthesia]. Masui. 200 1; 50(11712339):1085-8. 10. de Filho GRO, Gomes HP, da Fonseca MHZ, Hoffman JC, Pederneiras SG, Garcia JHS. Predictors of successful neuraxial block: a prospective study. Eur J Anaesthesiol. 2002;19 (1209492 0):447-5 11. Atallah MM, Demian AD, Shorrab AA. Development of a difficulty score for spinal anaesthesia. Br J Anaesth. 2004;92(14742333):354-60. 12. Wantman A, Hancox N, Howell PR. Techniques for identifying the epidural space: a survey of practice amongst anaesthetists in the UK. Anaesthesia. 2006;61(16548958):370-5 13. Chen SH, Chen SS, Lai CL, Su FY, Tzeng IS, Chen LK. Modified paramedian versus conventional paramedian technique in the residency training: an observational study. BMC Med Educ. 2020 Jul 2;20(1):211. 14. Kartal Seyfi & Kongur Esra. Evaluation Of the Median and Paramedian Approach in Spinal Anesthesia In Elderly Patients. Dicle Tıp Dergisi. 2020; 47: 243-249. 15. Harlocker T T retrospective review of 4767consecutive spinal anaesthetics. CNS complications. Anaesthesia analgesia. 1997; 84:561-7816. Singh P, Agrawal SK, Dwivedi S, Yadav A. A comparative evaluation between median and paramedian approaches for subarachnoid block in elderly patients. Int J Res Med Sci 2016; 4:2069-72. 17. Kanagarajan M, Vanishree C, Jeeva G, Median and paramedian approach for spinal anaesthesia for caesarean delivery: A comparative analysis of safety and effectiveness. Indian J Clin Anaesth 2017;4(4):518-522 18. Rafiei, M., Ghergherehchi, M. Comparison of the Severity of Injection Pain and Success in Spinal Anesthesia of Elderly Patients by Midline and Paramedian Approaches. Journal of Isfahan Medical School, 2007; 25(87) 19. Podder S, Kumar N, Yaddanapudi LN, Chari P. Paramedian lumbar epidural catheter insertion with patients in the sitting position is equally successful in the flexed and unflexed spine. Anesth Analg. 2004;99(15562081):1829-32 20. Schwabe K, Hopf HB. Persistent back pain after spinal anaesthesia in the nonobstetric setting: incidence and predisposing factors. Br J Anaesth. 2001 Apr;86(4):535-9. 21. Chakroborty B., Parvin S., Hossain M. M., & Hossain M. J. Self- Examination of Breast of the Students of Nursing College in Bangladesh. Journal of Medical Research and Health Sciences. 2022; 5(12): 2339–2344.