A Comparison of the Lateral Approach (Paramedian) Versus the Modified Lateral Approach (Modified Paramedian) in Spinal Anesthesia: Evaluating Ease of Procedure and Patient Satisfaction in Urological Surgeries; A Triple-Blind Randomized Clinical Trial

Abstract

Background: Spinal anesthesia (SA) is preferred over general anesthesia for lower extremity surgeries, but the optimal method of needle placement is debated. Although the paramedian approach reduces the risks of dural puncture, it presents technical difficulties. The modified paramedian technique may increase safety and patient satisfaction by facilitating subarachnoid access and overcoming anatomical challenges, particularly in obese or elderly patients. Objectives: This study aimed to compare the paramedian and modified paramedian techniques from the perspective of anesthesiologists and their impact on postoperative patient satisfaction. Methods: This triple-blind randomized clinical trial investigated the effects of two SA techniques — paramedian and modified paramedian — on patient satisfaction and procedural ease. A total of 112 patients meeting inclusion and exclusion criteria were enrolled. Data were collected using the Iowa Satisfaction with Anesthesia Care Questionnaire. Demographic information was recorded in coded form, and data analysis was performed using SPSS version 19. Statistical methods included the independent t-test for comparing continuous means between groups, the chi-square test for categorical variables, and logistic regression analysis to assess the impact of individual characteristics (age, gender, weight) on the ease of performing spinal anesthesia. Results: The results indicated that the modified paramedian group demonstrated superior performance in terms of success on the first attempt (P = 0.006), reduced need for repositioning (P = 0.038), and fewer repeated attempts (P = 0.017). Additionally, patient satisfaction scores were significantly higher in the modified paramedian group (P = 0.001). Multivariate regression confirmed age and Body Mass Index (BMI) as independent predictors of procedural difficulty (P < 0.05). Conclusions: The modified paramedian technique significantly enhanced the ease of SA administration and patient satisfaction compared to the traditional approach. These findings indicate its potential to improve the anesthesia process, reduce side effects, and elevate patient experience. This study supports broader adoption of the technique in surgical and healthcare settings, advancing anesthesia care quality.