Investigation of the effect of a modified paramedian and median approach on postspinal acute back pain in patients with spinal anesthesia in urological surgery

INTRODUCTION AND AİM: Postspinal backache can pose a problem for anesthetists and patients. In this study, we aimed to compare the median and modified paramedian approaches in terms of back pain rate after spinal anesthesia. MATERIALS AND METHODS: We included 297 volunteers between the ages of 20 and 80 who underwent spinal anesthesia in urological surgery between 15/07/2022 and 15/04/202. Spinal anesthesia was applied using median approach in Group M and a modified paramedian approach was performed in Group P. Demographic datas, ASA classification, BMI, surgery type, anesthesia and surgical position, duration of surgery, interspinous space, number of needle interventions, number of bone contacts, and hospital stay were recorded. The patients were contacted by phone on Day 1, Week 1, and Month 1, and back pain was questioned as absent, mild, moderate and severe. RESULTS: The incidence of backache on the postoperative 1st day, 1st week and 1st month was 55.9%, 26.3%, 3.4%. Group M was 70.3%, 39.5% and 5.9%, group P was 30.7%, 12.4%, 0.7%. Pain scores were significantly lower in the paramedian group (Day 1, Week 1, and Month 1; p=0.00,p=0.00,p=0.012). Patient satisfaction was significantly higher in the paramedian group (p=0.038). The number of needle attempts and bone contact were significantly lower in the paramedian group. (Group M: 1.3±0.5, Group P: 1.1±0.4; Group M: 0.9±0.9, Group P: 0.4±0,6; p=0.001, p=0.000). CONCLUSION: The back pain was lower when the modified paramedian approach compared to the median approach. In addition, modified paramedian approach reduced the number of needle attempts and bone contact. This might be the reason of the decreased incidence and severity of postspinal backache. Keywords: Postspinal Backache, Median Approach, Modified Paramedian Approach