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

Abstract

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.

Prevalence and Factors Associated with Back Pain among Patients Undergoing Spinal Anesthesia at the University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia: An Institutional Based Cross-Sectional Study

“…This result was consistent with the study done in Germany (40%) [ 21 ]. However, the current finding is higher than the reports in the Republic of Korea (32%) [ 38 ]. This might be due to the fact that patients who had multiple lumbar puncture attempts (>3 times) were included in our study.…”

Comparison of postoperative back pain between paramedian and midline approach for thoracic epidural anesthesia

“…The potential mechanism that initiates back pain following neuraxial anesthesia includes stretching or traumatic injury of ligaments, fascia, or bone with localized bleeding or injury to the adjacent nerve root. Musculoskeletal mechanisms are relaxation of the paraspinal muscles under anesthesia, flattening of the normal lumbar lordosis, immobility of the spine, and stretching of the joint capsules and paraspinal ligaments [ 1 , 2 , 6 , 7 ]. Especially, the lithotomy position can cause pelvic rotation, which aggravates the reduction in normal lumbar lordosis [ 6 ].…”

“…However, the paramedian technique can avoid such injury of midline ligaments by inserting the needle slightly away from the midline. Previous study also showed that spinal anesthesia with the paramedian technique could reduce the incidence of back pain compared to the midline technique [ 2 , 8 , 9 ]. A recent randomized study demonstrated that the incidence of back pain was 2% and 10% in the paramedian group and the midline group, respectively.…”

“…The reported incidence of back pain following epidural anesthesia ranges from 2% to 27%. Localized tissue trauma during needle entry and excessive stretching of the supraspinous and interspinous ligaments are possible mechanisms for the development of back pain following neuraxial anesthesia [ 1 , 2 ].…”

Transient involuntary movement disorder after spinal anesthesia: A case report

“…Intrathecally administration of spinal anesthesia is a common anesthetic technique used in lower extremity surgeries[ 1 ]. Neurological complications, such as hematoma, infections, and temporary or permanent spinal cord injuries, can occur after spinal anesthesia[ 2 ].…”