• R Stienstra, F van Poorten, and J W Kroon.
• Department of Anesthesiology, Reinier de Graaf Gasthuis, DELFT, The Netherlands.
• Anesth. Analg. 1989 Apr 1; 68 (4): 497-500.

AbstractThe effect of the direction of the spinal needle on the sensory level of anesthesia was investigated. Three ml plain bupivacaine 0.5%, previously equilibrated to 37 degrees C, were injected intrathecally in two groups of twenty patients, who were kept sitting for three minutes after injection. In patients in group 1 a paramedian approach was used with an angle between the spinal needle and the patient's back of 50 degrees or less. In patients in group 2 a median or paramedian approach was used, the resultant angle between the spinal needle and the patient's back being between 70 degrees and 100 degrees. The differences between segmental levels of sensory loss between groups 1 and 2 (T 3.4 and T 5.1, respectively) and of temperature loss (T 2.6 and T 4.2, respectively) 30 minutes after injection of bupivacaine were statistically significant. It is concluded that a steep paramedian approach of the subarachnoid space with an angle of less than 50 degrees results in a cephalad spread averaging about 1.6 segments greater than when the needle is in the perpendicular position.

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