{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:13:21Z","timestamp":1788416001709,"version":"build-2803163510"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"\n Study objective<\/jats:title>\n This randomized controlled trial aimed to determine whether an ultrasound-assisted modified paramedian approach could improve procedural outcomes compared with an ultrasound-assisted traditional paramedian approach for spinal anesthesia in patients undergoing lower limb surgery.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Prospective, randomized, controlled clinical trial.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Operating rooms of Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine, China.<\/jats:p>\n <\/jats:sec>\n \n Patients<\/jats:title>\n \n A total of 116 patients aged 18\u201390 years, with a body mass index of 18\u201330\u2005kg\/m\n 2<\/jats:sup>\n and ASA physical status I\u2013III, scheduled for lower limb surgery requiring spinal anesthesia were enrolled. Patients with contraindications to spinal anesthesia, previous lumbar surgery, scoliosis, or pregnancy were excluded.\n <\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n \n Patients were randomly assigned in a 1:1 ratio using a computer-generated random allocation sequence with concealed allocation to receive either ultrasound-assisted traditional paramedian spinal anesthesia (Group C,\n n<\/jats:italic>\n \u2009=\u200958) or ultrasound-assisted modified paramedian spinal anesthesia (Group M,\n n<\/jats:italic>\n \u2009=\u200958).\n <\/jats:p>\n <\/jats:sec>\n \n Main results<\/jats:title>\n \n Compared with Group C, Group M required fewer needle passes to achieve successful cerebrospinal fluid (CSF) flow [median [IQR]: 1 [1\u20132] vs. 2 [1\u20133],\n P<\/jats:italic>\n \u2009=\u20090.006] and demonstrated a higher first-pass success rate [37\/58 [63.79%] vs. 25\/58 [43.10%],\n P<\/jats:italic>\n \u2009=\u20090.026]. Group M also showed a shorter duration of the spinal procedure [12.5 [9.0\u201320.0] s vs. 15.0 [10.0\u201332.25] s,\n P<\/jats:italic>\n \u2009=\u20090.028] and shorter total procedure time [76.5 [65.0\u201389.25] s vs. 82.0 [72.0\u2013112.75] s,\n P<\/jats:italic>\n \u2009=\u20090.031]. The distribution of patient satisfaction scores differed between groups, with a higher proportion of patients reporting being \u201cvery satisfied\u201d in Group M (87.93% vs. 70.69%,\n P<\/jats:italic>\n \u2009=\u20090.040). The incidence of procedure-related and postoperative adverse events was comparable between groups, and no serious complications occurred.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The ultrasound-assisted modified paramedian approach was associated with fewer needle passes, improved first-pass success, and higher patient satisfaction ratings compared with the traditional paramedian approach, while without increasing short-term procedure-related adverse events. Further multicenter studies are warranted to determine whether these findings can be generalized to broader patient populations.<\/jats:p>\n \n Clinical Trial Registration:<\/jats:bold>\n https:\/\/www.chictr.org.cn\/showproj.html?proj=203874<\/jats:ext-link>\n , identifier ChiCTR2300075567.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fmed.2026.1903864","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:22:11Z","timestamp":1788412931000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-assisted modified paramedian approach vs. traditional paramedian approach for spinal anesthesia in lower limb surgery: a single-center randomized controlled trial"],"prefix":"10.3389","volume":"13","author":[{"given":"Wudong","family":"Zhuang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing)","place":["Cangzhou, Hebei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyuan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing)","place":["Cangzhou, Hebei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing)","place":["Cangzhou, Hebei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruizhao","family":"Lyu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing)","place":["Cangzhou, Hebei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Cangzhou People\u2019s Hospital","place":["Cangzhou, Hebei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Cangzhou Hospital of Integrated Traditional Chinese Medicine and Western Medicine","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Province Key Laboratory of Integrated Traditional and Western Medicine in Neurological Rehabilitation","place":["Cangzhou, Hebei Province, China"]},{"name":"Department of Anesthesiology and Perioperative Medicine, Hebei Key Laboratory of Integrated Traditional and Western Medicine in Osteoarthrosis Research (Preparing)","place":["Cangzhou, Hebei Province, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of 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