Median and Paramedian Approach in Spinal Anesthesia

Study Overview
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Brief Summary
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Spinal anesthesia (SA) is frequently used as anesthesia in many surgeries such as lower abdominal, inguinal, urogenital, rectal and lower extremities. Conventional median approach (MA) is preferred more frequently, although MA or paramedian approach (PA) is used in SA. Especially in geriatric patients due to degenerative changes Although we are told that degenerative changes are less affected in PA during SA in the geriatric age group, few studies have been conducted on the subject and we aimed to evaluate the superiority of the two methods.

Detailed Description
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In our study, 100 cases were planned to be evaluated prospectively. Patients scheduled for surgery under spinal anesthesia will undergo routine spinal preparation. After routine motorization, patients will be treated with MA or PA. MA will be performed in a conventional manner and PA will be performed by adding 1 cm lateral and 1 cm caudal from the planned vertebral space to 10-15 degree medial and cephal. If one of the patients with MA or PA fails, despite three attempts, the other method will be tried by another specialist. If the procedure fails or there are not enough blocks, a different anesthesia method will be applied. The data of the patients included in the study were evaluated by a different researcher other than the SA physician; demographic data of the cases, type of operation, MA or PA in SA and the number of repeated attempts / trials for the procedure will be evaluated.

Official Title
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Evaluation of Median and Paramedian Approach in Spinal Anesthesia in Elderly Patients

Conditions
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Efficacy, Self, Geriatric Patients

Intervention / Treatment
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* Procedure: median approach
* Procedure: paramedian approach


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients older than 70 years elective surgery under spinal anesthesia those who agreed to participate in the study Those with American Society of Anesthesiologists (ASA) 1-3 Exclusion Criteria: who use opioid or other non-steroidal anti-inflammatory drugs regularly who are allergic to a drug used in the study had contraindications for spinal anesthesia, drug addiction obese patients (Body Mass Index ≥ 35) migraine and chronic headache Spinal anesthesia can not be performed in more than 3 trials, but passed to the general anesthesia those who do not agree to participate in the study

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The aim of this study was to evaluate the success rate of median and paramedian approach in spinal anesthesia in geriatric patients, number of trials, number of attempts at another interval due to failure, duration of procedure, patient comfort, change to other method in case of failure and success rate. In the study, two groups were formed: the median approach and the paramedian approach.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: median approach<br>Spinal anesthesia will be performed with a conventional median approach | Procedure: median approach<br>* spinal anesthesia with median approach; is the known classical method and it is aimed to reach the spinal area from the middle line.<br>* Other names: classical approach;Procedure: paramedian approach<br>* In spinal anesthesia with a paramedian approach, 1 cm lateral and 1 cm caudal to reach the spinal area.<br>|
| Active Comparator: paramedian approach<br>Spinal anesthesia will be applied with a paramedian approach. | Procedure: median approach<br>* spinal anesthesia with median approach; is the known classical method and it is aimed to reach the spinal area from the middle line.<br>* Other names: classical approach;Procedure: paramedian approach<br>* In spinal anesthesia with a paramedian approach, 1 cm lateral and 1 cm caudal to reach the spinal area.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| spinal needle touches the spinal bone | The ability of getting a successful spinal anesthesia with a single skin puncture and no needle redirection. | during the procedure of spinal anesthesia | 
| Number of repeated attempts (attempts): | The ability of getting a successful spinal anesthesia with a single skin puncture and no needle redirection. | during the procedure of spinal anesthesia | 
| duration of procedure | In spinal anesthesia, the time to reach the skin and the spinal area will be evaluated. | during the procedure of spinal anesthesia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| success rate of spinal needle insertion | The ability of getting a successful spinal anesthesia with a single skin puncture regardless of needle redirection. | during the procedure of spinal anesthesia | 
| Complications of the procedure | complications of spinal anesthesia will be evaluated, during spinal anesthesia and during the first week | during the procedure of spinal anesthesia and 1 week after spinal anesthesia | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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median approach, paramedian approach, geriatric patient, spinal anesthesia