Incidence of newly developed postoperative low back pain with median versus paramedian approach for spinal anesthesia

BackgroundThe effects of anesthetic techniques on postdural puncture backache (PDPB) have not been specifically evaluated. The purpose of this study was to compare the incidence and severity of PDPB between median and paramedian techniques.MethodsPatients were randomized to receive spinal anesthesia by either a median (Group M, n = 50) or paramedian (Group P, n = 50) approach.We recorded each patient’s personal number of puncture attempts, surgical position, and operation duration. We investigated the incidence and intensity of back pain 1 day, 1 week, and 1, 2, and 3 months postoperatively.ResultsThe overall incidence of PDPB was higher in the Group M (18/50, 36%) than in the Group P (8/50, 16%) (P =0.023). Twenty-four hours after surgery, 8 patients in Group M and 6 patients in Group P complained of back pain, and the average numeric rating scale (NRS) pain scores showed no evidence of differences. Seven days after the surgery, 16 patients in the Group M and 5 patients in the Group P complained of pain (P = 0.007); their NRS scores did not significantly differ. After 1 month, 5 patients in the Group M and 1 patient in the Group P complained of pain. Only one patient in each group complained of pain after 3 months.ConclusionsThe results of this study suggest that spinal anesthesia using the paramedian approach reduces the incidence of PDPB during the early postoperative period.