Ultrasound-assisted spinal anaesthesia in obese parturients .

Background: Obesity poses significant technical challenges for neuraxial anesthesia in obstetric patients.Ultrasound guidance has improved success rates,but the optimal needle approach either midline or paramedian remains uncertain in obese parturients. Objective: To compare the midline and paramedian approaches of ultrasound-assisted spinal anesthesia in obese parturients undergoing cesarean section,with emphasis on technical performance, procedural efficiency,sonographic image quality, success rate, patient satisfaction, and complications. Methods: This prospective randomized study included 48 obese parturients (BMI ≥ 35 kg/m²) allocated into two groups: Group A (midline approach)and Group B (paramedian approach), each comprising 24 patients.Ultrasound was used for spinal landmark identification, and all procedures were performed using standardized techniques. Primary outcomes was success rate from first attempt Secondary outcomes included patient satisfaction, and pain intensity. Results: Group B achieved a significantly higher first-attempt success rate (\(50\%\)) compared to Group A (\(20.8\%\); \(p=0.035\)), although differences in patient satisfaction (\(p=0.39\)) and NRS pain scores (\(p=0.074\)) did not reach statistical significance. Conclusion: The ultrasound-guided paramedian approach provides superior technical success,improved image quality, shorter procedural times,and greater patient satisfaction compared with the midline approach in obese parturients.These findings support the paramedian approach as a more effective and reliable technique for spinal anesthesia in this high-risk population.