ADVANTAGE OF THE PARAMEDIAN APPROACH FOR LUMBER SPINAL ANALGESIA A CLINICAL COMPARISON BETWEEN MIDLINE AND PARAMEDIAN APPROACHES
Batra M.*, Saraf S., Khan P., Thakur K.K. and Gaikwad M.
ABSTRACT
Background: Spinal anaesthesia has increasingly become the technique of choice for lower segment caeserian
sections, vaginal hysterectomies etc due to quick onset of action and reliability in producing uniform sensory and
motor blockade and ease of administration Right from the time spinal was started, methods were sought to ease the
difficult spine, fused spine and obese patients. Especially for these difficult cases a paramedian technique was
devised which eases the procedure. The paramedian approach was associated with a lower frequency of technical
problems compared to the midline approach. Methods: Fifty patients, scheduled for lower segment caeserian
sections, were studied. The patients were randomly allocated to one of the two methods of spinal puncture,
midline or paramedian. Technical difficulties (in terms of no. of attempts, difficulty in identification of space) and
the occurrence of complications were recorded. The extent of sensory and motor blockade was also compared.
Results: The paramedian approach was associated with a lower frequency of technical problems compared to the
midline approach. Statistically significant difference were demonstrated between the two techniques for the
flowing factors: repeated attempts at needle insertion; difficulty in identification of the space; and the production
of parasthesiae (nine patients in the middle group compared to only one patient in the paramedian group, p<0.01).
No significant difference were demonstrated between the groups in the extent of sensory and motor blockade.
Conclusion: The study supports the view that the paramedian approach has technical advantages over the midline
approach for lumber spinal analgesia and is associated with lesser complications.
Keywords: Anatomy; spinal canal, median, paramedian Anaesthetic techniques.
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