1 Comparison of number of attempts of in standard paramedian approach (needle insertion 1cm lateral and 1cm caudal to spinous process) and modified paramedian approach with entry point 1cm lateral to spinous process.

2 Comparison of preprocedural ultrasound measured depth for needle insertion for spinal anaesthesia and actual depth of needle insertion while administrations of spinal anaesthesia using standard paramedian approach and modified paramedian approach.

3 Comparison of first attempt success rate in both paramedian groups.

1 Comparison of incidence of incidence of bloody tap in both groups.

2 Comparison of incidence of paraesthesia in both groups.

3 Comparison of incidence of post dural puncture headache in both groups within 24 hours postoperatively.

Spinal anaesthesia is most preferred technique for elderly patients with multiple comorbidities. Directing the needle into the vertebral canal is sometimes difficult in elderly patients because of narrow interspinous and interlaminar spaces. Preprocedural ultrasound scanning of spine before spinal anaesthesia help to overcome the common limitations like multiple attempts, postdural puncture headache, bloody tap and neurological injuries.

On reviewing the literature we could find that there is no consensus whether which approach is better or gold standard. There are many studies which comparing midline and paramedian approach but review of literature reveal very few or limited studies comparing preprocedural ultrasound assisted paramedian approach in elderly patients. Hence this particular study was undertaken.