This is only anecdotal, but this talk has revolutionised my labour ward oncall shifts here in the UK. It's 2020, so its now been 3 years (high hundreds of epidurals) and I almost exclusively now only do paramedian epidurals. The thing is, I get so much more sleep on a night shift now! Its uncanny! Epidural failure, unilateral blocks, bloody catheters, dural punctures, have pretty much stopped since starting this technique. I used to play around with the ultrasound a lot with midline approach, but since swapping to paramedian, its not needed. The only time I don't use paramedian is with super high BMI, where I know the space is likely to be 8cm+ anyway and I don't want to run out of needle by increasing the depth to space with the paramedian approach. Try it and you'll be surprised.
So a few years later, i tried it and to my surprise the results have been spectacular:) Unilatéral blocks used to happen twice in a row, now they almost never happen. Multiple failure is also gone.. i do get much more sleep at night😁. So the point is first thank you for your lecture. And second.. can you tell us why you do them in lateral position? Hope you see my message:) Thanks a lot
I have been using the paramedian approach as my preferred technique for just short of 40 years, and my results concur with everything you’ve said. The only hitch is that before needle placement you must develop a good feeling for the depth of your target, so that you can set your approach angle. When in doubt ultrasound is very helpful with this. The only remaining patient subgroup I revert to midline with are those with BMI’s over perhaps 45, because since the target is so far away ultra precision angulation is required.
