Background: Spinal anesthesia using the midline approach might be technically difficult in geriatric population. We\nhypothesized that pre-procedural ultrasound (US)-guided paramedian technique and pre-procedural US-guided\nmidline technique would result in a different spinal anesthesia success rate at first attempt when compared with\nthe conventional landmark-guided midline technique in elderly patients.\nMethods: In this prospective, randomized, controlled study, one hundred-eighty consenting patients scheduled for\nelective surgery were randomized into the conventional surface landmark-guided midline technique (group LM),\nthe pre-procedural US-guided paramedian technique (group UP), or the pre-procedural US-guided midline technique\n(group UM) with 60 patients in each group. All spinal anesthesia were performed by a novice resident.\nResults: The successful dural puncture rate on first attempt (primary outcome) was higher in groups LM and UM (77\nand 73% respectively) than in group UP (42%; P < 0.001). The median number of attempts was lower in groups LM and\nUM (1 [1] and 1 [1â??1.75] respectively) than in group UP (2 [1, 2]; P < 0.001). The median number of passes was lower in\ngroups LM and UM (2 [0.25â??3] and 2 [0â??4]; respectively) than in group UP (4 [2â??7.75]; P < 0.001). The time taken to\nperform the spinal anesthesia was not different between groups LM and UM (87.24 ± 79.51 s and 116.32 ± 98.12 s,\nrespectively) but shorter than in group UP (154.58 ± 91.51 s; P < 0.001).\nConclusions: A pre-procedural US scan did not improve the ease of midline and paramedian spinal anesthesia as\ncompared to the conventional landmark midline technique when performed by junior residents in elderly population.
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