Median and paramedian approach for spinal anaesthesia for caesarean delivery: A comparative analysis of safety and effectiveness

• Author Details:   
• Manisha Kanagarajan
• Vanishree C
• Gomathy Jeeva

---

Introduction: Spinal anaesthesia can be achieved either through the median or paramedian approach. The median approach may be technically difficult due to the exaggerated lumbar lordosis in pregnant patients. The paramedian approach is a useful technique in difficult or challenging situations like elderly and pregnant patients. The paramedian approach does not require the patient to fully reduce lumbar lordosis. A study was conducted on pregnant patients to evaluate the safety and efficacy of the paramedian approach.
Materials and Method: 100 parturients of ASA I-II who underwent caesarean delivery under spinal anaesthesia were divided into two groups:
a.        Group M (n=50) received spinal block through median approach while Group PM (n=50) received through paramedian approach.
b.        Number of attempts, success of the block, presence of paraesthesia, and the incidence of headache and lower backache were recorded in postoperative period.
c.        The data was analysed by using chi-square and T-test where P <0.05 was considered as statistically significant.
Results: In Group M, ten (20%) patients developed PDPH vs. five (10%) in group PM. Even though more patients developed post-dural puncture headache (PDPH) in median group, it was not statistically significant (P=0.161). There was no significant difference in the incidence of paraesthesia in both groups. The mean duration of onset of PDPH was similar in both groups (2.8 ± 0.8 vs. 2.7 ± 1.2 days).
Conclusion: Our study shows that paramedian approach is equally effective and may be helpful in reducing the incidence of PDPH and paraesthesia, and can be easily performed on pregnant patients.

Keywords: Caesarean delivery, Spinal anaesthesia, Median approach, Paramedian approach, PDPH.