Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass

Editor—The ideal way to provide spinal anaesthesia is via a single needle pass (i.e. a successful dural puncture, with a single skin puncture and no needle redirection). This was recommended by the Second American Society of Regional Anesthesia Consensus on Neuraxial Anesthesia and Anticoagulation.¹ Multiple puncture attempts are associated with a higher chance of complications.^2,3 A paramedian approach has been shown to improve the success rate of spinal anaesthesia, especially in patients who are unable to sit up or those with a degenerative spine condition.^4–6 The use of ultrasound has been suggested to increase the efficacy of spinal anaesthesia.⁷

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