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Comparison of Median and Paramedian Approach in Spinal Anaesthesia Using Whitacre Spinal Needle in Cesarean Surgery
Original Article

Background: Spinal anaesthesia is the most common anaesthesia techniques used for
Caesarean surgeries, median and paramedian approaches are two common techniques used for
spinal anaesthesia. The present study was conducted to compare both median and paramedian
approach in spinal anaesthesia in pregnant patients undergoing caesarean surgery in terms
of incidence of PDPH, ease of each approach and skin to subarachnoid distance in both the
approaches.
Materials and Methods: A total of 100 obstetric patients, undergoing cesarean surgery were
included in the study. Patients were randomly allocated into two groups. Group M (n=50)-
median approach and Group PM (n=50)- Paramedian approach.
Results: Mean number of attempts for successful spinal anesthesia were higher in Group
PM (paramedian 1.90+0.65) as compared to Group M (median 1.54+0.68). Mean skin to
subarachnoid distance was higher in Group PM (5.97 ± 0.13cms) as compared to Group M
(5.05 ±0.19cms). Nine patients presented with Post dural puncture headache out of total 100
patients. In Group M, six patients (12%) developed PDPH out of 50 patients while in group PM,
three patients (6%) developed PDPH, however, the difference was not statistically significant.
Conclusion: Paramedian approach is better than median approach in terms of reduction in
the frequency of PDPH, though the results were statistically insignificant. Skin to subarachnoid
distance (SSD) is significantly higher in paramedian approach as compared to median group.Keywords: Median approach; Paramedian approach; Post dural puncture headache;
Caesarean surgery.Keywords: Median approach; Paramedian approach; Post dural puncture headache;
Caesarean surgery.Keywords: Median approach; Paramedian approach; Post dural puncture headache;
Caesarean surgery.