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Indian Journal of Anesthesia and Analgesia

Volume  5, Issue 12, December 2018, Pages 2001-2006

 

Original Article

Spinal Anaesthesia with Midline and Paramedian Technique in Pregnant Patients undergoing Lower Segment Caesarean Section Under Spinal Anaesthesia
Deepasri Chowdhury1 Aparna Bagle2,Amruta Patil3
1Senior Resident 2Professor 3PG Resident, Department of Anaesthesia, Dr. D.Y. Patil Medical College and Research Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra 411018, India.
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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.51218.6

Abstract

  Background and AIMS: Subarachnoid blockade is widely used due to its simplicity, low cost and reduced complications due to general anaesthesia. Subarachnoid space can be approached from midline or paramedian approach (PMA). Accurate identification of the subarachnoid space is paramount as multiple attempts at needle insertion may cause patient discomfort, backache and Post Dural Puncture Headache (PDPH). The most commonly practiced technique is the midline approach. This approach is technically difficult in pregnant women due to inability to flex the spine adequately. The aim of the study is to compare the characteristics of midline approach (M) vs paramedian (P) for administration of spinal anaesthesia in patients posted for LSCS with respect to number of attempts, highest level of analgesia, duration of anaesthetic procedure and side effects such as blood tap, backache and PDPH after 48 hours. Materials and Method: 60 patients posted for caesarean section under spinal anaesthesia were divided into Group M: Spinal anaesthesia by Midline approach and Group P: Spinal Anaesthesia by Paramedian approach. The number of attempts, highest level of analgesia, duration of anaesthetic procedure and side effects such as blood tap, backache and PDPH after 48 hours were noted. Results: Paramedian group took fewer attempts and less time and a higher level of spinal block was achieved with the midline technique of spinal anaesthesia. Conclusion: Paramedian approach may be a better approach in the parturient as compared to the midline for administering spinal anaesthesia for LSCS. 

Keywords: Parturient for LSCS; Midline Spinal; Paramedian Spinal Technique


Corresponding Author : Dr. Aparna Bagle, Professor, Department of Anaesthesiology, Dr. D.Y. Patil Medical College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra 411018, India.