Background:The effects of the anesthetic technique 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. Methods:Patients were randomized to receive spinal anesthesia by either a median (M group, n = 50) or paramedian (P group, n = 50) approach. We recorded patients' personal number of puncture attempts, surgical position, and operation duration. We investigated the incidence and intensity of back pain at 1 day, 1 week, and 1, 2, and 3 months postoperatively. Results: The overall incidence of PDPB was higher in the M group (16/50, 32%) than in the P group (8/50, 16%). At 24 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 were comparable.At 7 days postoperatively, 16 patients in the M group and 5 in the P group complained of pain (P = 0.007); their NRS scores did not significantly differ (3.93 vs. 3.8, respectively). After one month, 5 patients in the M group and 1 patient in the P group complained of pain. The NRS score was 3.0 in both groups. Only one patient in each group continued to report pain at 3 months. Conclusions:The results of this study suggest that spinal anesthesia with the paramedian approach reduces the incidence of PDPB in the early postoperative period.