Incidence of postdural puncture headache following the median and para median approaches in spinal anesthesia - a randomized control study

Objectives: This study was conducted tocompare the incidence of post dural puncture headache between two methods of insertion of spinal needle i.e., median approach versus para median approach, and also to compare the incidence of other complications such as hypotension, bradycardia, nausea and vomiting, and rare adverse effects like photophobia.Methods: This was a hospital based prospective, randomized, control trial study conducted among 142 pregnant women who presented with uncomplicated pregnancy. The women were divided in two groups. Group A Spinal anaesthesia by median approach and group B -Spinal anaesthesia by paramedian approach. Results: PDPH (postdural puncture headache) was seen in 5/71 (7.04%) patients in group A versus patients in group B 2/71 (2.82%); with p value 0.245. In group A 15/71 (21.1%) complained of backache when compared with 9/71 (12.7%) in group B; p-value is statistically insignificant (p = 0.179). Vomiting was more with group A (1.41%) when compared to group B (0%) with p-value of 0.316. No patients complained of photophobia. The mean value of patients who had hypotension was 0.93 in group A and 0.79 in group B with a p-value of 0.697, statistically insignificant.Conclusion: The incidence of PDPH was higher in median approach of spinal anesthesia as compared to that in the paramedian approach. Hence, the paramedian approach of spinal anesthesia is preferred in pregnant women undergoing caesarean section.