The paramedian approach to the lumbar puncture is a great alternative to the traditional midline approach, and it’s ideal for patients who are difficult to position. Advantages are the larger target of the intralaminar space, avoidance of spinous ligaments, and increased first-attempt success. This procedure does have limitations with obese patients in whom landmarks are not identifiable.
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ACEP Now: Vol 36 – No 06 – June 2017
Dr. Crespo is an emergency physician at MetroHealth Medical Center in Cleveland.
Dr. Jones is director of the emergency ultrasound and the emergency ultrasound fellowship at MetroHealth Medical Center and associate professor at Case Western Reserve University School of Medicine, both in Cleveland.
References
- Tintinalli JE.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, NY: McGraw-Hill Education; 2011:1178.
- Duniec L, Nowakowski P, Kosson D, et al. Anatomical landmarks based assessment of intervertebral space level for lumbar puncture is misleading in more than 30%. Anaesthesiol Intensive Ther. 2013:45(1):1-6.
- Rabinowitz A, Bourdet B, Minville V, et al. The paramedian technique: a superior initial approach to continuous spinal anesthesia in the elderly. Anesth Analg. 2007;105(6):1855-1857.
- Leeda M, Stienstra R, Arbous MS, et al. Lumbar epidural catheter insertion: the midline vs. the paramedian approach. Eur J Anaesthesiol. 2005:22(11):839-842.
- Blomberg RG, Jaanivald A, Walther S. Advantages of the paramedian approach for lumbar epidural for lumbar epidural analgesia with catheter technique. A clinical comparison between midline and paramedian approaches. Anaesthesia. 1989;44(9):742-746.
- Bapat V, Vishwasrao S. Spinal anaesthesia with midline and paramedian technique in elderly patients. Indian J Appl Res. 2015:5:2249-2555.
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3 Responses to “Techniques for Performing Paramedian Approach to Lumbar Puncture”
June 18, 2017
C TPlease note that “Tintinalli” in Reference 1 is misspelled.
June 23, 2017
Dawn Antoline-WangThank you, I have corrected the misspelling.
February 22, 2023
AHBThanks for the article.