Incidence of newly developed postoperative low back pain with median versus paramedian approach for spinal anesthesia
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(3):14 Korean J Anesthesiol. 2020 Dec;73(6):518-524.What this means for my practice?
Findings of this trial suggest that the paramedian approach may lead to a reduction in the incidence of postdural puncture backache when compared to the median approach for spinal anesthesia. Limitations of this study include the lack of blinding of patients, the small sample size of 50 patients in each group, and the diversity of different surgeries included in the analysis. Future larger randomized controlled trials should confirm these findings by utilizing blinding of patients and performing comparisons by the type of surgery.
Study Summary
One hundred and twenty-four patients who were undergoing an elective surgery were randomized to receive spinal anesthesia via a paramedian (n=60) or median (n=64) approach. Outcomes of interest included pain evaluated using the numeric rating scale (NRS), incidence of back pain, patient satisfaction, the incidence of postdural puncture backache (PDPB), time of operation, bed rest time, and peri-operative use of analgesics (i.e. opioids and non-steroidal anti-inflammatory drugs [NSAIDs]). The incidence of pain and NRS pain scores were measured at 24 hours, 7 days, 1 month, 2 month, and 3 months follow-up. Results revealed the incidence of PDBP to be statistically significantly higher in the median approach group vs. paramedian approach (p=0.023). The incidence of pain after 7 days (p=0.007) and the total incidence of pain (p=0.023) were statistically significantly lower in the paramedian approach group compared to the median approach group. All other outcomes were not statistically significantly different between the 2 groups (p>0.05 for all).
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