Post-dural puncture headache: A comparison of median and paramedian approaches Dura delinmesine baǧli baş aǧrisi: Mediyan ve paramediyan yaklaşimlarin karşilaştirilmasi

TÜRKER Y. G. , GURBET A., KELEBEK GİRGİN N., Erşayli D. T. , Karaaǧaçli M. D. , Uçkunkaya N.

Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi, vol.33, no.2, pp.139-144, 2005 (Peer-Reviewed Journal) identifier

  • Publication Type: Article / Article
  • Volume: 33 Issue: 2
  • Publication Date: 2005
  • Journal Name: Turk Anesteziyoloji ve Reanimasyon Dernegi Dergisi
  • Journal Indexes: Scopus, TR DİZİN (ULAKBİM)
  • Page Numbers: pp.139-144
  • Keywords: Anaesthesia, Complications, Post-dural puncture headache, Spinal


Aim: The purpose of our study was to compare the incidences of post-dural puncture headache after spinal anesthesia with median or paramedian approaches. Materials and Methods: Four hundred ASA physical status I-III patients, aged between 30-80 years, scheduled for urologie surgery under spinal anesthesia were included to the study. The patients were randomly divided into two groups to receive heavy bupivacaine 0.5 %, 15 mg either using median or paramedian approach. Spinal anesthesia was performed at the L3-4 or L 4-5 interspace using a 25-G Quincke spinal needle with the patient in the left lateral decubitus position with median (Group M) or paramedian (Group P) approach. Patients were evaluated for typical post-dural puncture headache defined as bifrontal and occipital headache being aggravated by the upright position by an independent observer beginning from the first postoperative day. Results: Forty two of 400 patients (10.5 %) developed post-dural puncture headache. Comparing both groups, 16 (8 %) patients in Group M versus 26 (13 %) in Group P had typical post-dural puncture headache. Within the group of patients aged 30-40 years, the paramedian approach showed a significantly higher post-dural puncture headache rate compared with median approach (p<0.05). Conclusion: The results indicate that the incidence of post-dural puncture headache is higher in younger patients (30-40 years) when using the paramedian approach. However, our findings suggest that the choice of lumbar puncture technique is of little importance in regard of post-dural puncture headache in elderly patients.