INCIDENCE OF POST DURAL PUNCTURE HEADACHE: A COMPARATIVE ANALYSIS BETWEEN MEDIAN VERSUS PARAMEDIAN APPROACH TO SUB-ARACHNOID SPACE IN PATIENTS UNDERGOING ELECTIVE CESAREAN SECTION

Abstract

Background: Post dural puncture headache is the common complication after spinal anesthesia due to puncture of dura matter. This complication is frequent in Obstetric patients who obtains Neuraxial anesthesia during pregnancy and for deliveries. Young females are more vulnerable to this complication. Spinal anesthesia can be achieved with two approaches, one is Median(Midline) approach while another is Paramedian Approach. In this study, Females undergoing Cesarean section under spinal Anesthesia at LRH Peshawar were examined for the occurrence of PDPH and this examination was for the comparison of both Median and Paramedian approaches.

Methods: This study was a prospective Cohort study. Informed consent was gained from the participants included in the study. The research was conducted at LRH Peshawar KPK. A total of 216 patients were included in the study, which followed up for 72 hours post-operatively. The LRH/PIHMS ethics and research committee gave permission to conduct the study. The information was collected from patients through a questionnaire during follow-up. The data collected from the patients entered Statistical Package for Social Sciences(SPSS) version 27 for analysis.

Result: The Incidence of PDPH in patients who underwent cesarean section under spinal anesthesia at LRH Peshawar was 37(17.1%). 24 patients(11.11%) were from the median group while 13 patients(6.02%) were from paramedian approach. This comparison was statistically significant with p-value of 0.047. Incidence of PDPH was high in young aged obstetric patients mostly at the age between 18-27 years mostly within the first 48 hours of Spinal Anesthesia.

Conclusion: It is concluded from our study conducted at LRH Peshawar that incidence of Post Dural Puncture Headache in patients undergoing elective cesarean section under spinal anesthesia is high in Median approached group(11.1%) as compared to Paramedian approached group(6.02%). This comparison is statistically significant. So, it is concluded that Paramedian approach is better than Median approach for sub-arachnoid block in patients undergoing elective cesarean section.

Background: Post-dural puncture headache (PDPH) is a frequent complication following spinal anesthesia, especially among obstetric patients undergoing cesarean section. This condition is more prevalent in younger females and results from cerebrospinal fluid leakage due to dural puncture. Spinal anesthesia can be administered through either the median or paramedian approach. Understanding the comparative impact of these techniques on PDPH incidence is vital for optimizing patient care in obstetric anesthesia.

Objective: To assess and compare the incidence of PDPH in obstetric patients receiving spinal anesthesia via the median versus paramedian approach during elective cesarean sections.

Methods: This prospective cohort study was conducted at Lady Reading Hospital (LRH), Peshawar, after obtaining ethical approval from the LRH/PIHMS Ethics Committee. A total of 216 obstetric patients scheduled for elective cesarean sections under spinal anesthesia were enrolled following informed consent. Patients were equally divided into two groups: 108 received the median approach and 108 received the paramedian approach. Participants were monitored for PDPH symptoms over a 72-hour postoperative period. Data collection was carried out using a structured questionnaire and analyzed using SPSS version 27. The chi-square test was used for statistical analysis, with a p-value of <0.05 considered significant.

Results: Out of 216 patients, 37 (17.1%) developed PDPH. Among these, 24 patients (22.2%) were from the median group and 13 (12.0%) from the paramedian group. The difference in PDPH incidence between the two groups was statistically significant (p = 0.047). The majority of PDPH cases (n=23, 10.65%) occurred within the first 48 hours. PDPH was most frequent in patients aged 18–27 years (n=17, 7.87%).

Conclusion: The study concluded that the median approach is associated with a significantly higher incidence of PDPH compared to the paramedian approach. These findings support the clinical advantage of adopting the paramedian approach in obstetric spinal anesthesia to reduce PDPH risk.