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).