International Journal of Medical and All Body Health Research  |  e-ISSN: 2582-8940  |  Double-Blind Peer Review  |  Open Access  |  CC BY-NC-SA 4.0

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     2026:7/4

International Journal of Medical and All Body Health Research

e-ISSN: 2582-8940 | Open Access

A Study to Compare USG Aided and Landmark Guided Paramedian Spinal Anesthesia in Elderly Patients

Dr. Sakshi, Dr. Lokesh Kumar Gupta, Dr. Shailja Sharma, Dr. Ankur Sehgal, Dr. Khushboo, Dr. Wamiq Javed

Post Graduate Resident, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India; Professor, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India; HOD & Professor, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India; PG Resident, Department of Anaesthesia and Critical Care, Saraswathi Institute of Medical Sciences, Pilkhuwa, Hapur, Uttar Pradesh, India

Article Information

Volume / Issue6 / 3 (July-September 2025)
Pages155-160
AccessOpen Access

Publication Timeline

  • Received26 June 2025
  • Accepted25 July 2025
  • Published

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Abstract

Background and Objectives: Spinal anesthesia in elderly patients presents unique challenges due to anatomical changes, comorbidities, and technical difficulties. This prospective randomized controlled study aimed to compare the efficacy and safety of ultrasound-guided (USG) versus landmark-guided techniques for paramedian spinal anesthesia in elderly patients. 
Methods: A total of 120 patients aged 65 years and above, scheduled for lower limb and lower abdominal surgeries under spinal anesthesia, were randomly allocated into two groups: Group U (USG-guided, n=60) and Group L (landmark-guided, n=60). Primary outcomes included first-pass success rate, total procedure time, and number of attempts. Secondary outcomes evaluated patient comfort scores, hemodynamic stability, block characteristics, and complications. 
Results: The USG-guided group demonstrated significantly higher first-pass success rates (88.3% vs 66.7%, p<0.001), reduced total procedure time (8.2±2.1 vs 11.4±3.8 minutes, p<0.001), and fewer total attempts (1.2±0.4 vs 1.8±0.9, p<0.001) compared to the landmark-guided group. Patient comfort scores were significantly better in the USG group (7.8±1.2 vs 6.1±1.8, p<0.001). The USG group showed superior block characteristics with faster onset times and more predictable sensory levels. Hemodynamic parameters remained more stable in the USG group with fewer episodes of hypotension (8.3% vs 21.7%, p=0.045). 
Conclusion: Ultrasound guidance significantly improves the success rate, reduces procedure time, and enhances patient comfort during paramedian spinal anesthesia in elderly patients while maintaining excellent safety profiles
 

Keywords

Ultrasound-Guided Spinal AnesthesiaLandmark TechniqueElderly PatientsParamedian ApproachNeuraxial AnesthesiaRegional Anesthesia

References

  1. Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493-7. [Google Scholar][Crossref]
  2. Veering BT. The use of spinal anesthesia in elderly patients. Curr Opin Anaesthesiol. 2003;16(2):171-6. [Google Scholar][Crossref]
  3. Atallah MM, Shorrab AA, Abdel Mageed YM, Demian AD. Low-dose spinal anesthesia for percutaneous nephrolithotomy: the suitability and impact of adding intrathecal fentanyl. Acta Anaesthesiol Scand. 2006;50(7):798-803. [Google Scholar][Crossref]
  4. Hogan QH. Lumbar epidural anatomy. A new look by cryomicrotome section. Anesthesiology. 1991;75(5):767-75. [Google Scholar][Crossref]
  5. de Seze MP, Rezzouk J, de Seze M, Usson Y, Lavelle F, Moyse E, et al. Does the orgasmic platform exist? A systematic review. Int Urogynecol J. 2013;24(9):1459-69. [Google Scholar][Crossref]
  6. Balki M, Lee Y, Halpern S, Carvalho JC. Ultrasound imaging of the lumbar spine in the transverse plane: the International Journal of Medical and All Body Health Research www.allmedicaljournal.com correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 2009;108(6):1876-81. [Google Scholar][Crossref]
  7. Levy JH, Islas JA, Ghia JN, Turnbull C. A retrospective study of the incidence and causes of failed spinal anesthetics in a university hospital. Anesth Analg. 1985;64(7):705-10. [Google Scholar][Crossref]
  8. Broadbent CR, Maxwell WB, Ferrie R, Wilson DJ, Gawne-Cain M, Russell R. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia. 2000;55(11):1122-6. [Google Scholar][Crossref]
  9. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94(1):7-17. [Google Scholar][Crossref]
  10. Shaikh F, Brzezinski J, Alexander S, Arzola C, Carvalho JC, Beyene J, et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ. 2013;346:f1720. [Google Scholar][Crossref]
  11. Perlas A, Chaparro LE, Chin KJ. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg Anesth Pain Med. 2016;41(2):251-60. [Google Scholar][Crossref]
  12. Chin KJ, Perlas A. Ultrasonography of the lumbar spine for neuraxial and lumbar plexus blocks. Curr Opin Anaesthesiol. 2011;24(5):567-72. [Google Scholar][Crossref]
  13. Grau T, Leipold RW, Conradi R, Martin E, Motsch J. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med. 2001;26(1):64-7. [Google Scholar][Crossref]
  14. Carvalho JC. Ultrasound-facilitated epidurals and spinals in obstetrics. Anesthesiol Clin. 2008;26(1):145-58. [Google Scholar][Crossref]
  15. Costello JF, Balki M. Cesarean delivery under ultrasound-guided spinal anesthesia [corrected] in a parturient with poliomyelitis and Harrington instrumentation. Can J Anaesth. 2008;55(9):606-11. [Google Scholar][Crossref]
  16. Prasad GA, Tumber PS, Lupu CM. Ultrasound-guided spinal anesthesia. Can J Anaesth. 2008;55(10):716-7. [Google Scholar][Crossref]
  17. Chin KJ, Perlas A, Chan V, Brown-Shreves D, Koshkin A, Vaishnav V. Ultrasound imaging facilitates spinal anesthesia in adults with difficult surface anatomic landmarks. Anesthesiology. 2011;115(1):94-101. [Google Scholar][Crossref]
  18. Perlas A, Chaparro LE, Chin KJ. Lumbar neuraxial ultrasound for spinal and epidural anesthesia: a systematic review and meta-analysis. Reg Anesth Pain Med. 2016;41(2):251-60. [Google Scholar][Crossref]
  19. Neal JM, Brull R, Chan VW, Grant SA, Horn JL, Liu SS, et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: executive summary. Reg Anesth Pain Med. 2010;35(2):S1-9. [Google Scholar][Crossref]
  20. Tran DQ, Kamani AA, Al-Attas E, Lessoway VA, Massey S, Rohling RN. Single-operator real-time ultrasound-guidance to improve spinal anesthesia outcomes: a randomized comparison with traditional landmark technique. Anesth Analg. 2010;111(5):1265-71. [Google Scholar][Crossref]
  21. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-29. [Google Scholar][Crossref]
  22. Arzola C, Davies S, Rofaeel A, Carvalho JC. Ultrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals. Anesth Analg. 2007;104(5):1188-92. [Google Scholar][Crossref]
  23. Watson MJ, Evans S, Thorp JM. Could ultrasonography be used by an anaesthetist to identify a specified lumbar interspace before spinal anaesthesia? Br J Anaesth. 2003;90(4):509-11. [Google Scholar][Crossref]
  24. Whitty R, Moore M, Macarthur A. Identification of the lumbar interspinous spaces: palpation versus ultrasound. Anesth Analg. 2008;106(2):538-40. [Google Scholar][Crossref]

How to Cite

Sakshi, Gupta, L. K., Sharma, S., Sehgal, A., Khushboo, & Javed, W. (2025). A Study to Compare USG Aided and Landmark Guided Paramedian Spinal Anesthesia in Elderly Patients. International Journal of Medical and All Body Health Research, 6(3), 155-160. https://doi.org/10.54660/IJMBHR.2025.6.3.155-160

Sakshi, et al. "A Study to Compare USG Aided and Landmark Guided Paramedian Spinal Anesthesia in Elderly Patients." International Journal of Medical and All Body Health Research, vol. 6, no. 3, 2025, pp. 155-160. https://doi.org/10.54660/IJMBHR.2025.6.3.155-160.

Sakshi, Gupta, L. K., Sharma, S., Sehgal, A., Khushboo and Javed, W. (2025) 'A Study to Compare USG Aided and Landmark Guided Paramedian Spinal Anesthesia in Elderly Patients', International Journal of Medical and All Body Health Research, 6(3), pp. 155-160. doi: 10.54660/IJMBHR.2025.6.3.155-160.

Sakshi, Gupta LK, Sharma S, Sehgal A, Khushboo, Javed W. A Study to Compare USG Aided and Landmark Guided Paramedian Spinal Anesthesia in Elderly Patients. International Journal of Medical and All Body Health Research. 2025;6(3):155-160. doi:10.54660/IJMBHR.2025.6.3.155-160

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