Spinal Anesthesia With Modified Paramedian Approach : Copmarision With Classic Paramedian Approach

Abstract

In the present study, by introducing a modified paramedic method with a more convenient technique than the classical type with a few changes in the entry angle and distances from the midline, we conducted a study and the purpose of this study was to compare the success rate and convenience of spinal block procedure. The two classic paramedic techniques have been modified with the new technique. Materials and Methods: In this study, 200 patients were divided into two groups using randomization. In the study group (paramedic modified method) by an anesthesiologist, in a sitting position from the L3-L4 or L4-L5 space with a spinal needle No. 25 type Quinque, the puncture was performed by the paramedline method and depending on the duration of surgery 4-2 0.5 ml of bupivacaine was injected. The modified paramidline method was that after finding the L3-L4 or L4-L5 intervertebral space, with the thumb, the outer margin of the multifidus muscle, which is approximately one and a half centimeters lateral to the intervertebral space, Specify and then insert the spinal needle at an angle of approximately 20-25 degrees to the medial until the tip of the needle reaches the subarachnoid space. In the control group, the classical paramedic method was performed. In both groups, in addition to the patient's demographic information, the number of attempts by the operating physician to reach the spinal tap and the time to reach the successful block and the patient's satisfaction with the procedure, as well as the comfort of the anesthesiologist according to his previous experiences with classical methods. , More difficult, indifferent), was questioned and recorded by another colleague. Preoperative complications were also recorded. Results: Successful block was achieved in 90% of patients in the classical paramedic group and in 98% of patients in the modified paramedic group (P = 0.028). The range of time to reach successful block in patients with classical paramedic group was 21 seconds with a median of 18 seconds (p = 0.043). Comparing complications during puncture (blood aspiration, paresthesia and back pain) and post-puncture headache between the two groups of patients, no significant difference was observed between the two groups (P <0.05); Also, there was a significant difference in terms of patient satisfaction with the procedure between the two groups in favor of the new technique group (P = 0.005)