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65 Taylor´s approach to subarachnoid block in an elderly patient: a solution after failed conventional approach
  1. D Gonçalves,
  2. D Roriz,
  3. F Teixeira,
  4. JM Cardoso,
  5. AP Pereira and
  6. C Sampaio
  1. Centro Hospitalar Trás-os-Montes e Alto Douro, Vila Real, Portugal


Background and Aims The execution of spinal anesthesia in elderly patients can be difficult due to several anatomical degenerative alterations.

Taylor’s approach for neuraxial anesthesia is a safe, yet rarely used, alternative with a high success rate and might be useful specially in elderly.

Methods A 92-year-old female patient, ASA III, was scheduled for an urgent dynamic hip screw after left trochanteric fracture. After obtaining informed consent, an ultrasound-guided fascia Iliaca block was performed with 30 ml of 0,25% Levobupivacaine.

Subarachnoid block, using 27G and 25G Quincke® needle, with the median and paramedian approach was attempted unsuccessfully by two anesthetists at the level of L2-L3, L3-L4 and L4-L5 as the needle hit bone in all directions.

We decided one last attempt using Taylor’s approach and the spinal needle was inserted in a cephalo-medial direction, 1 cm medial and 1 cm caudally to the Posterior Superior Iliac Spine, the L5-S1 space was targeted and cerebrospinal fluid was obtained.

Results A satisfactory spinal block was achieved, which allowed surgery to proceed without complications. Patient´s hemodynamics were stable throughout the entire procedure and no adverse events were registered in the intraoperative nor postoperative period.

Conclusions The L5-S1 intervertebral space is usually the biggest one and targeting it (Taylor’s approach) might be useful in patients with degenerative changes as it may present an easier way to reach the subarachnoid space.

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