Paramedian Technique

This technique is especially useful in the mid thoracic region. Only attempt it after you are comfortable with the midline approach.

The spinous processes angle downwards, the interspinous spaces are small and needle needs to be directed much more cephalad than in the lumbar region. You will frequently encounter bone with a midline approach.

Using the paramedian approach, the needle is inserted at 90 degrees, level with the spinous process of the vertebra above and 1-2cm laterally. The needle is advaned slowly until the lamina is contacted. Then the needle is redirected to the midline and slighty cephalad walking off the lamina and into the ligamentum flavum. Then the loss of resistance technique is used.

 

Roll over the image to see the required directional change.