A study to compare median versus paramedian approach regarding incidence of postdural puncture headache under spinal anesthesia in cesarean section

Abstract

Background: Postdural puncture headache (PDPH) is an iatrogenic complication associated with spinal anesthesia. Median and paramedian are two common techniques used for spinal anesthesia. Female pregnant patients are important risk factors for PDPH. The present study was conducted to compare the incidence of PDPH in female pregnant patients undergoing cesarean section using median versus paramedian approach. Materials and Methods: A total of 200 obstetric patients, having physical status I or II, undergoing cesarean section were included in the study. Patients were randomly allocated into two groups. Group I (n = 100) – Median approach and Group II (n = 100) – Paramedian approach. Results: Single attempt was successful in 75 patients (75%) in group I and 80 patients (80%) in group II. Two attempts were used in 20 patients (20%) in group I and 19 patients (19%) in group II. PDPH was not observed in any patient with one or two attempts including both groups. Six patients presented with PDPH out of total 200 patients. In group I, five patients (5%) developed PDPH out of 100 patients while in group II, only one patient (1%) developed PDPH out of 100 patients; however, the difference was not significant statistically. Conclusion: There is no difference regarding the incidence of PDPH in obstetric patients between median and paramedian approach.

Keywords

• Median approach
• obstetric
• paramedian approach
• postdural puncture headache