Should the Paramedian Approach be the First Choice in Spinal Anesthesia of Geriatric Patients? Prospective Randomized Clinical Trial

Abstract

Objective:There are significant technical difficulties in spinal anesthesia for geriatric patients. Spinal anesthesia can be applied with a median or paramedian approach. This study aimed to evaluate the success rates and intraoperative complications of two approaches in spinal anesthesia for geriatric patients.Method:This prospective randomized study included 110 patients aged 60 years and older with ASA II-III status. The patients were randomly divided into the median (M) and paramedian (P) groups. Spinal anesthesia was performed on the patients at the L3-4 level. In case of failure in both approaches despite three attempts, an alternative method was applied. The patients’ demographic data, the number of interventions, the duration of the procedure, bone contact during the process, the need for an alternative approach, and intraoperative complications were recorded.Results:While the success rate at the first attempt was 56.6% in group M, it was 78.1% in group P. The duration of spinal anesthesia was significantly lower in group P (18±13 vs. 41±27 seconds, p<0.001). The mean number of attempts and bone contact were also significantly lower in group P (1.1±0.3 vs. 1.4±0.7, p=0.02, 30.9% vs. 52.8%, p=0.02, respectively). No significant difference was observed in terms of intraoperative complications.Conclusion:This study showed that the procedure time was significantly shortened in the paramedian approach in spinal anesthesia in geriatric patients, and there was less bone contact during the procedure. We think the paramedian approach may be the first choice in spinal anesthesia for geriatric patients.

Keywords

• geriatrics
• regional anesthesia
• spinal anesthesia