Comparison of median vs. paramedian techniques of spinal anesthesia in cesarean section

Aim and Spinal anesthesia is a very common anesthetic technique in cesarean section. It is usually applied through the median or paramedian approach among which the median approach is more common. The purpose of this study was to compare the median with paramedian approaches in elective cesarean section operations. Methods and Materials: This double -blind randomized clinical trial was performed on 150 patients between 15 to 45 years old. Patients were randomly assigned to receive either median or paramedian approach for spinal anesthesia. Vital signs were recorded before and after the procedure. The incidence of bradycardia and hypotension، nausea and vomiting، amount of ephedrine and atropine usage، post- dural puncture headache (PDPH)، and duration of recovery were collected and analyzed. The two groups were similar regarding age، weight and BMI. The other variables of the two groups were not significantly different (P>0. 05). Although a higher sensory block level was attained in the paramedian group compared with the median group (P=0. 007)، unexpectedly the incidence of nausea and vomiting was higher in the median group (P=0. 002) for which the difference was significant. The two groups were similar regarding many different variables، however due to a lower incidence of nausea and vomiting، and a higher block level; the paramedian approach may be a favorable choice for neuraxial block in cesarean section operations especially in the cases with difficult spinal anatomy.