MIDLINE VERSUS PARAMEDIAN APPROACH TO SPINALANESTHESIA FOR CAESAREAN DELIVERY: IT MAY BE BETTER NOT TO BE IN THE MIDDLE!

Subarachnoid block (SAB) more popularly called as Spinal anesthesia, remains a golden standard technique of anesthesia in caesarean delivery given its simplicity, reliability, safety and cost effectiveness. and particularly many signicant advantages of the later technique compared to General anesthesia pertinent to this population group. The most commonly approach to spinal anesthesia till date remains the midline approach. But in pregnant women, given their limited ability to ex the spine, and also to lumbar lordosis associated with term pregnancy, the midline approach may be difcult at times as the success of the later depends much on the exibility of the lumbar spine. So, the paramedian approach to the subarachnoid space that does not depend on the patient's spine exibility is always a better option in the patients for caesarean delivery. Aim of the study The aim of our study was to compare was to compare the midline and paramedian approach to Spinal anesthesia in terms of number of attempts, time taken to complete the effective injection into the subarachnoid space, and side effects like post dural puncture headache (PDPH) and backache resulting from the subarachnoid injection. Materials and methods Sixty patients posted for elective and Emergency Caesarean section were randomly divided into two groups of 30 patients each. In one group SAB was established by using the midline approach and in the other group, the subarachnoid space was accessed by using paramedian approach as a primary technique to achieve subarachnoid block. The patients were followed up for 72 hours post procedure to take note of complications like backache and PDPH and managed accordingly. Results SAB using Paramedian approach was established in fewer attempts and in less time compared to the midline approach. The risk of complications like PDPH and backache associated with spinal anesthesia were also observe less to occur with paramedian approach than with midline approach. Conclusion Paramedian approach to SAB is a better option than midline approach for spinal anesthesia technique in patients for caesarean deliveries; the former approach requires relatively fewer attempts and the procedure time and risk of complications are lesser compared to the later approach.