Paramedian technique of spinal anesthesia in elderly patients for hip fracture surgery.

The objective of this study was to observe the success rate, difficulties and complications during the technique of spinal anesthesia through para median approach in elderly frail patients with spinal abnormalities, for femur fracture surgery. Case series study was performed at Pakistan Naval Shifa Hospital, Karachi, Pakistan from August 2002 to July 2003, after approval from Scientific Research Council of the Hospital and consent of the patients. Forty elderly patients with spinal abnormalities, ASA II, age 88+/- 8 years, weight 68.5+/-3.5 kg, declared high-risk for anesthesia, scheduled for femur fracture surgery under spinal anesthesia, were selected for study after failure of lumbar puncture (LP) through midline approach at L3-4 or L4-5 level. First routine LP was performed, if failed, then second LP through para median approach was attempted. The success rate of the para median approach was 100%. In 4 patients (10%) there was bloody tap and LP was done after selecting another space or re-adjusting the needle in the same space. Forty percent patients felt paraesthesia during the advancement of spinal needle into the sub-arachnoid space. In conclusion, in the elderly frail patients with spinal deformity, declared high-risk for general anesthesia and where lumbar puncture through midline approach fails due to spinal abnormalities, para median route is an alternate safe approach with success rate of 100%.