Paramedian Approach for Subarachnoid Blockade – A Marvellous Technique having Less Attention

Abstract

At present central neuroaxial blockade, e.g. subarachnoid blockade (SAB) or epidural blockade (EB), especially the former one, is widely used by the clinical anaesthesiologists due to its procedural simplicity, low cost & better physiological benefits and thus reduced complications than that of general anaesthesia (GA). Subarachnoid or epidural spaces can be traversed from the posterior aspect of the body either through a midline approach (MA) or a paramedian approach (PMA). There is another approach described as ‘lumbosacral puncture' or Taylor's approach, which actually is a variant of conventional paramedian approach. Theoretically, subarachnoid & epidural spaces can also be approached through the paravertebral foramen or even via an anterior intraoperative approach through the intervertebral discs1. The most common & popular technique is the MA. But the PMA (both conventional & Taylor's) is also a very easy & effective technique that can be practiced routinely as well as for some clearly indicated cases. The requirement for this procedure is the same as for the MA except having some ideas about the offmidline anatomy.

Keywords: Blockade, subarachnoid; approach, paramedian.

Journal of BSA, Vol. 19, No. 1 & 2, 2006 p.51-53