Median versus paramedian methods on the incidence of postdural puncture headache in women under spinal anesthesia: a systematic review

Headache after spinal anesthesia is a common problem in pregnant women undergoing cesarean section with spinal anesthesia. Among the regional anesthesia methods, spinal anesthesia is one of the most common methods for cesarean section, which is mainly performed with median and paramedian techniques. Therefore, this systematic review study was conducted with aim to compare two methods of median and paramedian on the incidence of postdural puncture headache (PDPH ) in women under spinal anesthesia.

In this systematic review study, to find the related articles, Scopus, PubMed, Magiran, SID, Medlib, Cochrane, Science Direct databases and Google Scholar search engine were searched using the keywords of median, paramedian, postdural puncture headache, caesarean section, and spinal anesthesia in both Persian and English languages without time limit until 20 May 2023. Jadad checklist was used to evaluate the quality of the articles.

The studies entered in the systematic review included 11 studies and the studies were conducted in 2009-2021. A total of 1195 patients with anesthesia class 1 and 2 were included in the study. In 4 studies, there was no statistically significant difference between the two groups of median and paramedian approaches. In 6 studies, the paramedian method caused fewer headaches than median method. In one study, median method caused fewer headaches than paramedian method.

The use of the paramedian method compared to the median technique can cause a lower incidence of PDPH after cesarean surgery. It is suggested that anesthesiologists use the paramedian technique for spinal anesthesia for women undergoing cesarean surgery, if possible, in order to prevent or reduce the occurrence of PDPH after surgery in these patients.