Key result
Modified paramedian approach increases first-attempt spinal anesthesia success to ~86% vs conventional approach.
Why the study?
The optimal method of needle placement for spinal anesthesia in lower extremity surgeries is debated, with challenges in the paramedian approach and potential benefits of the modified paramedian technique.
Does the modified paramedian approach improve procedural ease and patient satisfaction compared to the paramedian approach in patients undergoing urological surgeries with spinal anesthesia?
RCT (n=112)
Triple-blind
Block randomization
No
Does the modified paramedian approach improve procedural ease and patient satisfaction compared to the paramedian approach in patients undergoing urological surgeries with spinal anesthesia?
Absolute Event Rate: 85.7% vs 60.7%
p-value: p=0.006
The modified paramedian technique for spinal anesthesia significantly improves procedural success and patient satisfaction compared to the traditional paramedian approach.
Favors modified paramedian approach for spinal anesthesia in urological procedures; extends randomized evidence on neuraxial technique optimization.
Background: Spinal anesthesia (SA) is preferred over general anesthesia for lower extremity surgeries, but the optimal method of needle placement is debated. Although the paramedian approach reduces the risks of dural puncture, it presents technical difficulties. The modified paramedian technique may increase safety and patient satisfaction by facilitating subarachnoid access and overcoming anatomical challenges, particularly in obese or elderly patients. Objectives: This study aimed to compare the paramedian and modified paramedian techniques from the perspective of anesthesiologists and their impact on postoperative patient satisfaction. Methods: This triple-blind randomized clinical trial investigated the effects of two SA techniques — paramedian and modified paramedian — on patient satisfaction and procedural ease. A total of 112 patients meeting inclusion and exclusion criteria were enrolled. Data were collected using the Iowa Satisfaction with Anesthesia Care Questionnaire. Demographic information was recorded in coded form, and data analysis was performed using SPSS version 19. Statistical methods included the independent t-test for comparing continuous means between groups, the chi-square test for categorical variables, and logistic regression analysis to assess the impact of individual characteristics (age, gender, weight) on the ease of performing spinal anesthesia. Results: The results indicated that the modified paramedian group demonstrated superior performance in terms of success on the first attempt (P = 0.006), reduced need for repositioning (P = 0.038), and fewer repeated attempts (P = 0.017). Additionally, patient satisfaction scores were significantly higher in the modified paramedian group (P = 0.001). Multivariate regression confirmed age and Body Mass Index (BMI) as independent predictors of procedural difficulty (P < 0.05). Conclusions: The modified paramedian technique significantly enhanced the ease of SA administration and patient satisfaction compared to the traditional approach. These findings indicate its potential to improve the anesthesia process, reduce side effects, and elevate patient experience. This study supports broader adoption of the technique in surgical and healthcare settings, advancing anesthesia care quality.
No takes yet. Share an insight, caveat, or question.
Kiaei et al. (2025) conducted an RCT in Urological surgeries requiring spinal anesthesia (n=112). Modified paramedian approach vs. Paramedian approach was evaluated on Success on the first attempt of spinal anesthesia (p=0.006). The modified paramedian approach significantly increased the first-attempt success rate of spinal anesthesia to 85.7% compared to 60.7% with the conventional paramedian approach.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: