Comparison of post-spinal back pain after midline versus paramedian approaches for urologic surgeries

Dadkhah, Payman; Hashemi, Masoud; Gharaei, Babak; Bigdeli, Mohammad Hassan; Solhpour, Ali

doi:10.1186/s42077-020-00088-5

Comparison of post-spinal back pain after midline versus paramedian approaches for urologic surgeries

Authors

10.1186/s42077-020-00088-5

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; = 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.

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