Paramedian versus midline approach of spinal anesthesia: A systematic review and meta-analysis with trial sequential analysis
Document Type
Article
Publication Date
1-1-2024
Abstract
Purpose: Midline approach of spinal anesthesia has been widely used for patients undergoing surgical procedures. However, it might not be effective for obstetric patients and elderly with degenerative spine changes. Primary objective was to examine the success rate at the first attempt between the paramedian and midline spinal anesthesia in adults undergoing surgery. Methods: Databases of MEDLINE, EMBASE, and CENTRAL were searched from their starting date until February 2023. Randomized clinical trials (RCTs) comparing the paramedian versus midline approach of spinal anesthesia were included. The primary outcome was the success rate at the first attempt of spinal anesthesia. Results: Our review included 36 RCTs (n = 5379). Compared to the midline approach, paramedian approach may increase success rate at the first attempt but the evidence is very uncertain (OR: 0.47, 95 CI 0.27–0.82, ρ = 0.007, level of evidence:very low). Our pooled data indicates that the paramedian approach likely reduced incidence of post-spinal headache (OR: 2.07, 95 CI 1.51–2.84, ρ < 0.00001, level of evidence:moderate). The evidence suggests that the paramedian approach may result in a reduction in the occurrence of paresthesia (OR: 1.61, 95 CI 1.06–2.45, ρ = 0.03, level of evidence:low). Conclusions: Our meta-analysis of 36 RCTs showed that paramedian approach may result in little to no difference in success rate at the first attempt owing to its very low level of evidence. However, given the low level of evidence and studies with small sample sizes, these findings need to be interpreted with caveat. Clinical Trial Registration Number: CRD42023397781. © 2023, The Author(s) under exclusive licence to Japanese Society of Anesthesiologists.
Keywords
Anesthesia, Back pain, Paresthesia, Post-dural puncture headache, Spinal, Spinal puncture
Divisions
anaesthesiology
Funders
None
Publication Title
Journal of Anesthesia
Volume
38
Issue
1
Publisher
Springer