Rationale of modified paraspinous/paramedian technique for spinal anesthesia in prevention of post dural puncture headache after cesarean section

Background & Objective: The spinal anesthesia in cesarean sections is still marred by post dural puncture headache (PDPH) and low backache. Both complaints sometimes becomes very troublesome for the patient and the anesthesiologists. This study evaluated the incidence of PPDH with modified paraspinous paramedian and median traditional approaches for spinal anesthesia during cesarean sections. Methodology: For this randomized, controlled double-blind study, 60 primigravida parturients undergoing cesarean section under spinal anesthesia were randomized into 2 groups (30 each). Group 1 received spinal anesthesia with the classic median approach and Group 2 received spinal anesthesia with the modified paraspinous paramedian approach. All the patients were followed up to 7 days postoperatively. The incidence of PDPH and low backache was observed in each group. Results: The present study showed a statistically significant lower incidence and lower severity of PDPH in Group 2 in which a modified paraspinous paramedian approach was used, compared to Group 1 (p < .05) in which median classic approach was used. The difference in the incidence of back pain was non-significant. Conclusion: Spinal anesthesia with the modified paraspinous/ paramedian approach for cesarean section is associated with a lower incidence of PDPH when compared to the standard median approach.