Comparison of post-spinal back pain after midline versus paramedian approaches for urologic surgeries
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(2020) 12:41
ORIGINAL ARTICLE
Ain-Shams Journal of Anesthesiology
Open Access
Comparison of post-spinal back pain after midline versus paramedian approaches for urologic surgeries Payman Dadkhah, Masoud Hashemi, Babak Gharaei, Mohammad Hassan Bigdeli and Ali Solhpour*
Abstract Introduction: Low back pain after spinal anesthesia is of concern in lithotomy position. During our study, low back pain in both midline and paramedian approaches after spinal anesthesia in lithotomy position was compared. Material and methods: Spinal anesthesia was performed by two approaches of midline and paramedian by an expert. The midline at middle line and paramedian at 1 cm inferior and 1 cm lateral to the spinous process performed with the needle type of Quincke 25G. The severity of back pain in patients was measured with numerical rating scale method by an anesthesiology assistant 24 and 72 h and a week after surgery. Results: A total of 139 patients were studied. After 24 h, back pain in the midline group was 21% and in the paramedian group was 25.4%, respectively. There were no significant differences between them. In the first 24 h, the only significant variable was the number of tries. In patients with ≥ 2 times of tries for performing spinal anesthesia, multivariate analysis of patients showed back pain to be 4.7 times more common compared to single try (OR 4.70, CI 1.79–10.18; p = 0.001). Conclusion: There were no significant differences between the two methods of midline and paramedian approaches after spinal anesthesia in the incidence of back pain. However, two or more times of tries compared with one time try had increased risk of low back pain. Keywords: Back pain, Spinal anesthesia, Lithotomy position
Introduction Neuraxial blockade has a wide range of clinical applications for urology surgical procedures. Single-injection spinal anesthesia with local anesthetic is the most common procedure in current anesthesia for urologic procedures. Spinal neuraxial blocks result in a sympathetic blockade, sensory analgesia, or anesthesia and motor blockade, depending on the dose, concentration, or volume of local anesthetic, after insertion of a needle in subarachnoid space (Maffulli et al. 1991). There are two common approaches to reach subarachnoid space. The midline approach relies on the ability of * Correspondence: [email protected] Anesthesiology Department, Labbafinejad Hospital, Anesthesiology Research, Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
patients and assistants to minimize lumbar lordosis and allow access to the subarachnoid space between adjacent spinous processes (Miller and Pardo 2015). The depth of the dura from the skin in patients of normal body habitus is 5.1 ± 1.0 cm (Gnaho et al. 2012). Spinal needle designs imply the difference in the incidence of postdural puncture headache and backache and success rate of dural puncture (Pan et al. 2004). The paramedian approach exploits the larger “subarachnoid target” that exists if a needle is inserted slightly
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