Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients

• Main Authors: Seyfi Kartal, Esra Kongur, Seyhan Sümeyra Aşcı, Hasan Rıza Aydın, Pınar Duman Aydın, Ahmet Şen
• Format: Article
• Language: English
• Published: Dicle University Medical School 2020-06-01
• Series: Dicle Medical Journal
• Subjects: spinal anesthesia; median; paramedian; geriatric patient.
• Online Access: http://diclemedj.org/upload/sayi/77/Dicle%20Med%20J-03962.pdf

Objective: Spinal anesthesia is frequently used in many surgical procedures. Although both median and paramedian approaches are used in spinal anesthesia, the conventional median approach is preferred. Reportedly, degenerative changes in elderly patients are less affected by the paramedian approach during spinal anesthesia. In this study, we aim to determine which of the two methods is superior in elderly patients. Method: This study, patients were treated with the median approach or paramedian approach during spinal anesthesia after appropriate procedural preparation. Results: Overall, 103 patients were included in the study. The success rate was 90.5% in the paramedian approach and 79.1% in the median approach. The duration of the procedure was shorter in the paramedian approach than in the median approach (14.4 ± 8.2 versus 28.4 ± 24.9, p = 0.004). During the procedure, the repetition from another interval was more in the median approach than in the statistically insignificant level due to the contact with the spinal bones and failure. The average age of the patients with the procedure duration was <30 s was higher than those with procedure duration ≥30 s. Conclusions: In elderly patients, the success rate of the paramedian approach in the first attempt and repeated trials increased, the procedure time was shortened, and the surgery could be performed more comfortably without touching the spinal bones independent of the flexion position. Therefore, we believe that the paramedian approach is a faster, safer, and more successful method compared with the median approach in elderly patients.