An evaluation of median and paramedian approach for spinal anaesthesia in caesarean delivery
Keywords:
Median, Paramedian, LSCS, Spinal AnaesthesiaAbstract
Introduction : Spinal anesthesia can be achieved either through the median or paramedian approach. hence we evaluated the median and Paramedian Approach by following variables - Number of attempts, success of the block, presence of paraesthesia, the level of sensory level, and the incidence of head ache and lower back ache. Methods: The present Retrospective analytical comparative study is carried out on the records of 100 subjects . Records of the Patients were divided into two groups: Group ME (n=50) received spinal anaesthesia with median approach and Group PM (n=50) received through paramedian approach. Results: In Group ME, 12 (24%) patients developed PDPH vs. 6 (12%) in Group PM, which was not statistically significant . 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 Conclusions : Our study shows that paramedian approach is equally effective and may be helpful in reducing the incidence of PDPH and paraesthesia, and it can be easily performed in pregnant patients.
Downloads
References
P.H. Conroy, C. Luyet, C.J. McCartney, and P.G. McHardy. Real Time Ultrasound-Guided Spinal Anaesthesia: A Prospective Study of a New Approach. Anaesthesiology Research and Practice. 2013.
Wantman A, Hancox N, and Howell PR. Techniques for identifying the epidural space: a survey of practice amongst anaesthetists in the UK. Anaesthesia 2006;61:370-5.
Boon JM, Prinsloo E, Raath RP. A paramedian approach for epidural block: an anatomic and radiologic description. Reg Anesth Pain Med 2003;28:221-7.
Frank RL. Lumbar puncture and post-dural puncture headaches: Implications for the emergency physician. The Journal of emergency medicine. 2008;35(2):149-57.
Wu CL, Rowlingson AJ, Cohen SR, Michals RK, Courpas GE, Joe EM et al. Gender and post-dural puncture headache. Anesthesiology. 2006;105(3):613-8.
Munnur U, Suresh MS. Backache, headache, and neurologic deficit after regional anaesthesia. Anesthesiol Clin North America 2003;21:71-86.
Oomura M, Yamawaki T, Miyashita K, Yamagami H, and Narimoti H. Disappearance of migraine attacks during long-lasting post-dural puncture headache: a case report. Headache 2002;42:356-8.
Kurtz KM, Kokmen E, Stevens JC, et al. Post-lumbar puncture headaches, Experience in 501 consecutive procedures. Neurology 1992;42:1884-7.
Cesur M, Alici HA, Erdem AF, Silbir F and Celik M. Decreased incidence of headache after unintentional dural puncture in patients with caesarean delivery administered with postoperative epidural analgesia. J Anaesthesia 2009;23:31-35.
Vilming S, Kloster R. Post-lumbar puncture headache: Clinical features and suggestions for diagnostic criteria. Cephalgia 1997;17:778-84.
Haider S, Butt KJ, Aziz M, Qasim M. Post-dural puncture head ache- A comparison of Midline and Paramedian Approaches. Biomedica 2005;21:90-2.
Mosaffa F, Karimi K, Madadi F, Hasankhoshnevis S, Besheli LD, Eajaji A. Post-dural puncture headache: A comparison between median and paramedian approaches in orthopaedic patients. Anaesthesiology and Pain medicine. 2011;1(2):66-9.
Leeda M, Stienstra R, Arbous MS, Dahan A, Th Veering B, Burm AG, et al. Lumbar epidural catheter insertion: the midline Vs the paramedian approach. Eur J Anaesthesiol 2005;22(11):839-42.
Richardson MG, Wissler RN. Density of Lumbar cerebrospinal fluid in pregnant and nonpregnant humans. Anaesthesiology 1996;85:326-30.
Datta S, Hurley RJ, Naulty JS, et al. Plasma and cerebrospinal fluid progesterone concentrations in pregnant and nonpregnant women. Anesth Analg 1986;65:950-4.
Grant R, Condon B, Hart I, et al. Chenges in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry 1991;54:440-442.
Hatfalvi BI. Postulated mechanisms for postdural puncture headache and a review of laboratory models. Reg Anaesth 1995;20:329-36.
Miyazawa K, Shiga Y, Hasegawa T et al. CSF hypovolemia vs intracranial hypotension in spontaneous intracranial hypotension syndrome. Neurology 2003;60:941-947.
Camann WR, Murray RS, Mushlin PS et al. Effects of oral caffeine on post dural puncture headache. A double- blind, placebo-controlled trial. Anesth Analg 1990;70:181-184.
Mohammad zadeh Jooriabi A, Haghighi M, Naderi NabiB. Incidence of Post-dural Puncture Headache in Patients undergoing Caesarean section in Alzahra Hospital. Journal of Ghlian University of Medical Sciences. 2003;12(48):213-7.
Haghighi M, Mardani M, Sedighi Nejad A, Mohammad zadeh A, Etehad H, Soleymanha M. Evaluation of correlative factor of Backache and headache after spinal anaesthesia in orthopaedic surgery. Journal of Ghlian University of Medical Sciences. 2012;21(82):31-8.
Hamiri H. Prevalence of low back pain in caesarean section in Javahery hospital. Journal of Medical Science Islamic Azad University. 2005;15:31-8.
Turnbull DK, Shepherd DB. Postdural puncture headache: pathogenesis, prevention and treatment: a prospective study of 1021 spinal anaesthesia. Anesth Analg 1990;70:389-94.
Sadeghi A, Razavi SS, Gachkar L, Sh S. Evaluation of effective parameters for methods of anaesthesia in caesarean section. Anaesthesiology & Intensive care 2009;30(65).
Grau T, Leipold Rw, Horter J, Canradi R, Martin Eo JM. Paramedian access to the epidural space – the optimum window for ultrasound imaging. J Clinical Anaesthesia 2001;13(3):213-7.
Blomberg RG, Jaanivald A, and Walther S. Advantages of the paramedian approach for lumbar epidural analgesia with catheter technique: a clinical comparison between midline and paramedian approaches. Anaesthesia 1989;44:742-6.
Brown EM, Elemen DS. Postoperative backache. Analgesia 1961;40:683.
Dahl JB, Schultz P, Anker Moller E, Christensen EF, Staunstrud HG, Carrison P. Spinal anaesthesia in young patients using a 29-gauge needle: technical consideration of postoperative compliant comparison between general Anaesthesia 1990; B J A: 64.
Khajavi M, Chamani Tabriz A, Shariat Moharreri R, Etezadi F, Najafi A. Evaluation of leg elevation on reduction of recovery time after spinal anaesthesia.
Journal of Iranian Society of Anaesthesiology & Intensive Care 2011;1-2.
Davignon KR, Dennehy KC. Update on postdural puncture headache. Int Anesthesiol Clin 2002;40:89-102.
Angel PJ, Kronberg JE, and Thompson DE, et al. Dural tissue trauma and cerebrospinal fluid leak after epidural needle puncture: effect of needle design, angle, and bevel orientation. Anesthesiology 2003;99:1376-82.
Suryasa, I.W., Sudipa, I.N., Puspani, I.A.M., Netra, I.M. (2019). Translation procedure of happy emotion of english into indonesian in kṛṣṇa text. Journal of Language Teaching and Research, 10(4), 738–746
Published
How to Cite
Issue
Section
Copyright (c) 2022 International journal of health sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.
Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.
