Observation of single spinal anesthesia by 25G needle puncture through a lateral crypt for hip surgery in elderly patients

Abstract

Background: Lumbar spine hyperosteogeny and ligament calcification are common in the elderly and anesthesia puncture through the conventional approach is difficult in this age group, and repeated puncture can increase the risk of spinal hematoma and nerve injury. This study aimed to observe the feasibility and safety of single spinal anesthesia administered with 25G needle through the lateral crypt for lower-extremity fracture surgery in elderly patients. Methods: The subjects were 60 elderly patients in our hospital (aged 65–80 years; ASA grades I and II) scheduled for lower-extremity fracture surgery (procedure was predicted to last within 2 h) under single spinal anesthesia by different approaches through L 3 – 4 . They were randomly divided into 2 groups: in the first group, 25G needle was used in a vertical approach (group C, n=30); in the second, 25G needle was passed through the inner edge of the small joints of L 3 – 4 to the lateral crypt (group L, n=30). After successful completion of the puncture procedure, 2.5 mL of 0.5% hyperbaric ropivacaine was used for spinal anesthesia. We then recorded the puncture times, sensory block level, and adverse reactions (e.g., headache, lumbago, and lower limb pain). Results: No significant differences in onset time, sensory block level and adverse reaction were noted between the 2 groups. The puncture success rate in group L was not significantly higher and the number of attempts per puncture was not significantly less than that in group C (93.3% vs 70%) ( P = .063). Nerve-root irritation was more frequent in group L than in group C but with no significant difference ( P > .05). Conclusion: Single spinal anesthesia through the lateral crypt approach is safe and effective for lower-extremity fracture surgery in elderly patients. Thus, this approach is a feasible alternative when the conventional approach fails.

Ultrasound-assisted modified paramedian technique for spinal anesthesia in elderly

“…Currently the midline and paramedian techniques are widely applied for spinal anesthesia in the elderly. In contrast to previous studies [ 13 , 20 , 21 ], our work showed that in the paramedian technique group only the time taken to perform spinal anesthesia was significantly reduced. The reason could lie in the different definitions of first-attempt success rate, and the practical abilities of the operators.…”

“…Currently the midline and paramedian techniques are widely applied for spinal anesthesia in the elderly. In contrast to previous studies [13,20,21], our work showed In order to explore the effects of the three techniques in patients of different ages, all patients were divided into two groups according to age for subgroup analysis. It was found that there were some differences between patients aged 65-74 years and those ≥75 years old.…”

Artificial Intelligence-Based CT Imaging on Diagnosis of Patients with Lumbar Disc Herniation by Scalpel Treatment

“…LDH is a clinically common degenerative spine disease, which will adversely affect the quality of life and work ability of patients. Lateral crypt block treatment can converge drugs at the site of the lesion, thereby effectively eliminating nerve root inflammation and edema, which is an effective nonsurgical treatment [ 12 ]. The scalpel treatment can release the patient's bone fibrous tube, supraspinous and interspinous ligaments, facet joint capsule, etc.…”

Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study

“…First, the puncture site for spinal anesthesia was L 2-3 , considering that previous studies have provided some dosage options for L 3-4 . 25 , 29 And due to factors such as hyperosteogenesis and ligament calcification in elderly patients, 30 there are always some cases of failed puncture in the L 3-4 space. At that time, L 2-3 is a safe additional choice.…”