Which Approach is Preferred in Spinal Anesthesia: Median or Paramedian? Comparison of Early and Late Complications

Abstract

Spinal anesthesia is often preferred in short-term surgeries because it is a low-cost technique that can be applied easily, has a high success rate, and allows fast mobilization and early feeding (1). The side effects in this application can vary with the technique that is used (2). Inadequate spinal anesthesia, high or total spinal block, cardiac arrest, respiratory arrest, systemic toxic reaction, hypotension, bradycardia, nausea/vomiting, headache, spinal puncture pain, meningitis or meningismus, neurological sequelae, urinary retention, and hearing loss may be seen as a result of the effect created by the spread of the local anesthetic agent in the subarachnoid space (3).In our study, we aimed to compare the early and late complication rates of two different techniques (median or paramedian approach) in spinal anesthesia, which is the most preferred anesthetic method in our clinic for short-term surgeries. Material and MethodsOur study was conducted after the ethics committee approval no. 42883194-01/10405, dated November 18th, 2014, was received from the Ethics Committee of Fırat University Hospital. Of 282 patients who underwent short-term surgeries under spinal anesthesia between January 1st, 2014, and March 1st, 2014, 80 patients aged 18-65 years and classified as ASA I/II/III according to the American Society of Anesthesiologists (ASA) classification, who could be reached at telephone numbers that we had on file, were included in the study. Since the study was retrospective, informed consents were not received from the patients. The files of the patients were obtained from the archive, and the patients in whom the median technique was used were included in Group M (n=40), and those in whom the paramedian technique was used were included in Group P (n=40). Demographic data (age, gender, height, weight), ASA, the number of spinal anesthesia applications, duration of surgery, preoperative and intraoperative heart rate (HR), and mean arterial pressure (MAP) were recorded from the anesthesia follow-up chart, and the discharge durations from the hospital and the number of patients who underwent urinary catheterization were recorded from the nurse observation forms. Information was received from the patients who were contacted by phone about postoperative headache, pain at the site of procedure, hearing complaints, and about the other complaints. Which Approach is Preferred in Spinal Anesthesia: Median or Paramedian? Comparison of Early and Late ComplicationsIntroduction: Spinal anesthesia is usually preferred for short-time surgery; the side effects of the process can show difference with techniques. We aimed to compare early and late complications of median and paramedian techniques in spinal anesthesia.Methods: Eighty patients with American Society of Anesthesiologists (ASA) I-III were allocated into the following two groups: Group M (median) and Group P (paramedian). Demographic data of the patients, ASA score, number of spinal anesthesia application, total surgery time, discharge time from the hospital, h...

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

“…In contrast, Rabinowitz et al 8 found that the success rate was 85% with the PA and 45% with the MA in their study in which 40 patients were included. In other similar studies, the success rate was found to be 100% with the PA and 90% with the MA 9,10 . In this study, the success rate was found to be 90.5% with the PA and 79.1% with MA, which is similar to studies 9,10,12 .…”

“…However, it was stated that longer spinal needles should be used for the PA. The success rate was found to be 90% with the PA and 70% with the MA by Sing et al 9 , 92% with the PA and 68% with the MA by Ali et al 7 , and 60% with the by Ahsan ul-haq et al 10 . In our study, the attempt from another space due to failure was not statistically significant, however, it was more with the MA.…”

“…In elderly patients, the procedure is painful and difficult due to their reduced ability to complete the flexion position due to the decrease in the distance between the joints, calcification, and degeneration 7,9 . In the PA, since the ligamentum flavum directly reaches from the paravertebral muscles instead of supraspinous and interspinous ligaments, problems due to degenerative change in elderly patients could be avoided 10,11 .…”

Comparative study of midline versus paramedian approach of spinal block in elderly.

“…Contrary to this, Nisar A et al 17 who studied 100 pregnant patients undergoing caesarean section under spinal block, concluded that incidence of spinal headache was higher with paramedian approach. A study conducted by Bayindir S and colleagues 5 in Turkey compared the early and late complications associated with median versus paramedian approach, found no statistically significant difference between the two. However, the study was not restricted to any specific age group.…”

“…Thus the technique of applying spinal block and experience matters to avoid such drawbacks. 5 It is usually performed by midline approach. While using the midline approach at the desired level the needle passes through skin, subcutaneous tissue, supraspinous ligament, interspinous ligament ligamentum flavum, epidural space, dura mater, arachnoid mater and finally subarachnoid space.…”