INCIDENCE OF POST DURAL PUNCTURE HEADACHE: A COMPARATIVE ANALYSIS BETWEEN MEDIAN VERSUS PARAMEDIAN APPROACH TO SUB-ARACHNOID SPACE IN PATIENTS UNDERGOING ELECTIVE CESAREAN SECTION
Keywords:
Cesarean Section, Obstetric Anesthesia, Paramedian Approach, Post-Dural Puncture Headache, Spinal Anesthesia, SPSS, Young Adults.Abstract
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.
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