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

Year 2020, Volume: 47 Issue: 2, 243 - 249, 17.06.2020
https://doi.org/10.5798/dicletip.748556

Abstract

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.

References

  • 1.Cook TM, Counsell D, Wildsmith JA. Royal collegeof anaesthetists third national audit project. Majorcomplications of central neuraxial block: report onthe third national audit project of the royal collegeof anaesthetists. Br J Anaesth 2009; 102: 179-90.
  • 2.Firdous T, Siddiqui MA, Siddiqui SM. Frequency of post dural puncture headache in patientsundergoing elective cesarean section under spinalanesthesia with median versus paramedianapproach. Anaesth Pain & Intensive Care 2016; 20:165-70.
  • 3.Puolakka R, Haasio J, Pitkänen MT, et al. Technical aspects and postoperative sequelae of spinal andepidural anesthesia: a prospective study of 3,230orthopedic patients. Reg Anesth Pain Med 2000; 25:488-97.
  • 4.Conroy PH, Luyet C, McCartney CJ, et al. Real-timeultrasound-guided spinal anaesthesia: a prospective observational study of a new approach. Anesthesiol Res Pract 2013; 2013: 525818.
  • 5.S Kartal, B Kösem, H Kılınç, et al. Comparison ofepidrum, epi-jet and loss of resistance syringetechniques for identifying the epidural space inobstetric patients. Niger J Clin Pract 2017; 20: 992-7.
  • 6.Wantman A, Hancox N, Howell PR. Techniques foridentifying the epidural space: a survey of practiceamongst anaesthetists in the UK. Anaesthesia 2006;61: 370 –5.
  • 7.Ali SM, Dash S, Mohapatra R. Spinal anaesthesiawith median and paramedian approach in geriatricpatients undergoing lower limb surgery IJMAS2016; 3:130-5.
  • 8.Rabinowitz A, Bourdet B, Minville V, et al. Theparamedian technique: a superior initial approachto continuous spinal anesthesia in the elderly.Anesth Analg 2007; 105: 1855-7.
  • 9.Singh P, Agrawal SK, Dwivedi S, et al. Acomparative evaluation between median andparamedian approaches for sub-arachnoid block inelderly patients. Int J Res Med Sci 2016; 4: 2069-72.
  • 10.Bayındır S, Özcan S, Koçyiğit F, et al. Whichapproach is preferred in spinal anesthesia: medianor paramedian? Comparison of early and latecomplications. İstanbul Med J 2017; 18: 205-9.
  • 11.Ahsan-ul-Haq M, Amin S, Javaid S. Paramediantechnique of spinal anesthesia in elderly patients for hip fracture surgery. J Coll Physicians Surg Pak2005; 15: 160–1.
  • 12.Muranaka K, Mizutani H, Seo K, et al. Acomparison between midline and para medianapproaches for combined spinal-epiduralanaesthesia. Masui 2001; 50: 1085-8.
  • 13.Podder S, Kumar N, Yaddanapudi LN, et al.Paramedian lumbar epidural catheter insertionwith patients in the sitting position is equallysuccessful in the flexed and unflexed spine. AnesthAnalg 2004; 99: 1829 –32.
  • 14.Haider S, Butt KJ, Aziz M, et al. Post duralpuncture headache-a comparison of midline andparamedian approaches. Biomedica 2005; 21: 90-2.
  • 15.Mosaffa F, Karimi K, Madadi F, et al. Post-duralpuncture headache: a comparison between medianand paramedian approaches in orthopedic patients.Anesth Pain Med 2011; 1: 66–69.
  • 16.Sadeghi A, Razavi SS, Gachkar L, et al.Comparison of the incidence of post spinalheadache following median and para medianapproach in cesarean patients. J Iranian Soc.Anesthesiol Intens Care 2009; 31: 4-9.
  • 17.Türker G, Gurbet A, Kelebek Girgin N, et al. Duradelinmesine bağlı başağrısı: Median ve paramedianyaklaşımların karşılaştırılması. Türk Anest ReanDer 2005; 33: 139.
Year 2020, Volume: 47 Issue: 2, 243 - 249, 17.06.2020
https://doi.org/10.5798/dicletip.748556

Abstract

References

  • 1.Cook TM, Counsell D, Wildsmith JA. Royal collegeof anaesthetists third national audit project. Majorcomplications of central neuraxial block: report onthe third national audit project of the royal collegeof anaesthetists. Br J Anaesth 2009; 102: 179-90.
  • 2.Firdous T, Siddiqui MA, Siddiqui SM. Frequency of post dural puncture headache in patientsundergoing elective cesarean section under spinalanesthesia with median versus paramedianapproach. Anaesth Pain & Intensive Care 2016; 20:165-70.
  • 3.Puolakka R, Haasio J, Pitkänen MT, et al. Technical aspects and postoperative sequelae of spinal andepidural anesthesia: a prospective study of 3,230orthopedic patients. Reg Anesth Pain Med 2000; 25:488-97.
  • 4.Conroy PH, Luyet C, McCartney CJ, et al. Real-timeultrasound-guided spinal anaesthesia: a prospective observational study of a new approach. Anesthesiol Res Pract 2013; 2013: 525818.
  • 5.S Kartal, B Kösem, H Kılınç, et al. Comparison ofepidrum, epi-jet and loss of resistance syringetechniques for identifying the epidural space inobstetric patients. Niger J Clin Pract 2017; 20: 992-7.
  • 6.Wantman A, Hancox N, Howell PR. Techniques foridentifying the epidural space: a survey of practiceamongst anaesthetists in the UK. Anaesthesia 2006;61: 370 –5.
  • 7.Ali SM, Dash S, Mohapatra R. Spinal anaesthesiawith median and paramedian approach in geriatricpatients undergoing lower limb surgery IJMAS2016; 3:130-5.
  • 8.Rabinowitz A, Bourdet B, Minville V, et al. Theparamedian technique: a superior initial approachto continuous spinal anesthesia in the elderly.Anesth Analg 2007; 105: 1855-7.
  • 9.Singh P, Agrawal SK, Dwivedi S, et al. Acomparative evaluation between median andparamedian approaches for sub-arachnoid block inelderly patients. Int J Res Med Sci 2016; 4: 2069-72.
  • 10.Bayındır S, Özcan S, Koçyiğit F, et al. Whichapproach is preferred in spinal anesthesia: medianor paramedian? Comparison of early and latecomplications. İstanbul Med J 2017; 18: 205-9.
  • 11.Ahsan-ul-Haq M, Amin S, Javaid S. Paramediantechnique of spinal anesthesia in elderly patients for hip fracture surgery. J Coll Physicians Surg Pak2005; 15: 160–1.
  • 12.Muranaka K, Mizutani H, Seo K, et al. Acomparison between midline and para medianapproaches for combined spinal-epiduralanaesthesia. Masui 2001; 50: 1085-8.
  • 13.Podder S, Kumar N, Yaddanapudi LN, et al.Paramedian lumbar epidural catheter insertionwith patients in the sitting position is equallysuccessful in the flexed and unflexed spine. AnesthAnalg 2004; 99: 1829 –32.
  • 14.Haider S, Butt KJ, Aziz M, et al. Post duralpuncture headache-a comparison of midline andparamedian approaches. Biomedica 2005; 21: 90-2.
  • 15.Mosaffa F, Karimi K, Madadi F, et al. Post-duralpuncture headache: a comparison between medianand paramedian approaches in orthopedic patients.Anesth Pain Med 2011; 1: 66–69.
  • 16.Sadeghi A, Razavi SS, Gachkar L, et al.Comparison of the incidence of post spinalheadache following median and para medianapproach in cesarean patients. J Iranian Soc.Anesthesiol Intens Care 2009; 31: 4-9.
  • 17.Türker G, Gurbet A, Kelebek Girgin N, et al. Duradelinmesine bağlı başağrısı: Median ve paramedianyaklaşımların karşılaştırılması. Türk Anest ReanDer 2005; 33: 139.
There are 17 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Articles
Authors

Seyfi Kartal This is me

Esra Kongur This is me

Publication Date June 17, 2020
Submission Date September 30, 2019
Published in Issue Year 2020 Volume: 47 Issue: 2

Cite

APA Kartal, S., & Kongur, E. (2020). Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients. Dicle Tıp Dergisi, 47(2), 243-249. https://doi.org/10.5798/dicletip.748556
AMA Kartal S, Kongur E. Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients. diclemedj. June 2020;47(2):243-249. doi:10.5798/dicletip.748556
Chicago Kartal, Seyfi, and Esra Kongur. “Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients”. Dicle Tıp Dergisi 47, no. 2 (June 2020): 243-49. https://doi.org/10.5798/dicletip.748556.
EndNote Kartal S, Kongur E (June 1, 2020) Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients. Dicle Tıp Dergisi 47 2 243–249.
IEEE S. Kartal and E. Kongur, “Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients”, diclemedj, vol. 47, no. 2, pp. 243–249, 2020, doi: 10.5798/dicletip.748556.
ISNAD Kartal, Seyfi - Kongur, Esra. “Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients”. Dicle Tıp Dergisi 47/2 (June 2020), 243-249. https://doi.org/10.5798/dicletip.748556.
JAMA Kartal S, Kongur E. Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients. diclemedj. 2020;47:243–249.
MLA Kartal, Seyfi and Esra Kongur. “Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients”. Dicle Tıp Dergisi, vol. 47, no. 2, 2020, pp. 243-9, doi:10.5798/dicletip.748556.
Vancouver Kartal S, Kongur E. Evaluation Of The Median And Paramedian Approach In Spinal Anesthesia In Elderly Patients. diclemedj. 2020;47(2):243-9.