Department of Anesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia.
Department of Anesthesiology, University of Glasgow, Glasgow, G12 8QQ, UK.
J Anesth. 2024 Feb;38(1):65-76. doi: 10.1007/s00540-023-03281-6. Epub 2023 Nov 29.
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.
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.
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).
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.
CRD42023397781.
脊柱麻醉的中线入路已广泛应用于接受手术的患者。然而，对于产科患者和退行性脊柱改变的老年患者可能效果不佳。主要目的是检验成人手术中旁正中与中线脊柱麻醉首次尝试的成功率。
从 MEDLINE、EMBASE 和 CENTRAL 的起始日期检索至 2023 年 2 月的数据库。纳入比较旁正中与中线脊柱麻醉入路的随机临床试验（RCT）。主要结局是脊柱麻醉首次尝试的成功率。
我们的综述纳入了 36 项 RCT（n=5379）。与中线入路相比，旁正中入路可能会增加首次尝试的成功率，但证据极不确定（OR：0.47，95%CI 0.27-0.82，ρ=0.007，证据水平：极低）。我们的汇总数据表明，旁正中入路可能降低术后头痛的发生率（OR：2.07，95%CI 1.51-2.84，ρ<0.00001，证据水平：中）。有证据表明，旁正中入路可能减少感觉异常的发生（OR：1.61，95%CI 1.06-2.45，ρ=0.03，证据水平：低）。
我们对 36 项 RCT 的荟萃分析表明，由于证据水平极低，旁正中入路在首次尝试的成功率上可能差异不大。然而，鉴于证据水平低且研究样本量小，这些发现需要谨慎解释。
CRD42023397781。
