IJMABHR International Journal of Medical and All Body Health ResearchIJMABHR 2582-8940 Anfo Publication House 378 10.54660/IJMBHR.2025.6.3.155-160 A Study to Compare USG Aided and Landmark Guided Paramedian Spinal Anesthesia in Elderly Patients Sakshi GuptaLokesh Kumar SharmaShailja SehgalAnkur Khushboo JavedWamiq 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 02082025 6 3 155 160 26062025 25072025 CC BY-NC-SA 4.0

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

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