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

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.