A Comparison between The Incidence of Paresthesia in Median and Paramedian Approaches of Intrathecal Anesthesia in Parturients Undergoing Cesarean Sections: A Randomized Controlled Trial

Reham Mahrous; Mahmoud Alalfy; Hatem Hassan; Omar  Nagy; Omnia Mandour; Amera Yehia; Amr K. Abdel Hakeem

doi:10.3889/oamjms.2021.6595

Authors

Reham Mahrous Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Giza, Egypt https://orcid.org/0000-0001-8884-5689
Mahmoud Alalfy Department of Reproductive Health and Family Planning, National Research Centre, Dokki, Egypt; Department of Obstetrics and Gynecology, Aljazeerah Hospital, Giza, Egypt https://orcid.org/0000-0002-8429-6376
Hatem Hassan Department of Reproductive Health and Family Planning, National Research Centre, Dokki, Egypt; Department of Obstetrics and Gynecology, Aljazeerah Hospital, Giza, Egypt
Omar Nagy Department of Reproductive Health and Family Planning, National Research Centre, Dokki, Egypt; Department of Obstetrics and Gynecology, Aljazeerah Hospital, Giza, Egypt
Omnia Mandour Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Giza, Egypt https://orcid.org/0000-0003-2826-8546
Amera Yehia Department of Obstetrics and Gynecological Diseases, Cairo University, Giza, Egypt
Amr K. Abdel Hakeem Department of Anesthesia, Surgical ICU, and Pain Management, Cairo University, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2021.6595

Keywords:

Parethesia, Neurological complications, Intrathecal anesthesia, Ceseresan section, Median, Paramedian

Abstract

BACKGROUND: Paresthesia with intrathecal anesthesia occurs when the entry of the needle causes an uncomfortable pain, burning, or electric sensation that usually radiates to the buttocks or legs. The importance of avoiding paresthesia is to lower the risk of postoperative neurological problems, in addition to reducing the incidence of that unpleasant sensation. The majority of reported occurrences of nerve injury caused by spinal anesthesia were preceded by paresthesia during the spinal anesthesia needle insertion. To the best of our knowledge, no studies have been done to compare the incidence of paresthesia in cesarean sections using median and paramedian routes to provide spinal anesthetic.

AIM: Our study aimed to compare the incidence of paresthesia in the median and paramedian approaches of intrathecal anesthesia to predict its association with nerve injury.

METHODOLOGY: Two hundred-ninety-six parturients scheduled for elective cesarean sections under spinal anesthesia were in the study from November 2020 to January 2021. They were divided into two groups. The median group (n = 157) and the paramedian group (n = 135) according to the approach used for providing spinal anesthesia. The incidence of paresthesia was compared between both groups. The number of trials in each approach and the occurrence of postoperative neurological complications (for example: nerve injury, paraplegia, or foot drop) were also documented.

RESULTS: The sample size was calculated based on a pilot study that was conducted before the original study. The calculated sample size was based on an alpha error of 0.05 and 90% power. The incidence of paresthesia was higher in the median group (10.7%) than the paramedian (3.7) group with statistical significance (p = 0.039). In both groups, no postoperative neurological problems were noted in any groups.

CONCLUSION: The median group has significantly more incidence of paresthesia than the paramedian group. The significance of this finding is that the paramedian approach is expected to be less likely to cause neurologic problems during spinal anesthesia.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

World Health Organization. Caesarean Section Rates. Geneva: World Health Organization; 2015. p. 8.

Miseljic N, Basic E, Miseljic S. Causes of an increased rate of caesarean section. Mater Sociomed. 2018;30(4):287-9. https://doi.org/10.5455/msm.2018.30.287-289 PMid:30936794 DOI: https://doi.org/10.5455/msm.2018.30.287-289

van Erp M, Ortner C, Jochberger S, Klein KU. Recent standards in management of obstetric anesthesia. Wien Med Wochenschr 2017;167:374-89. https://doi.org/10.1007/s10354-017-0584-0 PMid:28744777 DOI: https://doi.org/10.1007/s10354-017-0584-0

Boon JM, Prinsloo E, Raath RP. A paramedian approach for epidural block: An anatomic and radiologic description. Reg Anesth Pain Med. 2003;28(3):221-7. https://doi.org/10.1097/00115550-200305000-00009 PMid:12772140 DOI: https://doi.org/10.1097/00115550-200305000-00009

Freshour CR, Constance D. ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. NIH Public Access. 2018;33(5):404-15. PMid:18774509 DOI: https://doi.org/10.1097/00115550-200809000-00003

Emami SA, Sahebkar A, Javadi B. Paresthesia: A review of its definition, etiology and treatments in view of the traditional medicine. Curr Pharm Des. 2015;22(3):321-7. https://doi.org/10.2174/1381612822666151112145348 PMid:26561077 DOI: https://doi.org/10.2174/1381612822666151112145348

Imbelloni LE, Gouveia MA. Paresthesia in spinal anesthesia. In: Imbelloni LE, Gouveia MA, editors. Paresthesia. Rijeka: IntechOpen; 2012. https://doi.org/10.5772/1567 DOI: https://doi.org/10.5772/1567

Esther B, Hans-Fritz G, Marcus MA. Paraesthesia in Regional Anaesthesia. Paresthesia. Berlin, Germany: ResearchGate; 2012. https://doi.org/10.5772/35541 DOI: https://doi.org/10.5772/35541

Imbelloni LE, Pitombo PF, Ganem EM. The incidence of paresthesia and neurologic complications after lower spinal thoracic puncture with cut needle compared to pencil point needle. Study in 300 patients. J Anesthe Clinic Res. 2010;1:106. http://doi.org/10.4172/2155-6148.1000106. DOI: https://doi.org/10.4172/2155-6148.1000106

Kanagarajan M, Vanishree C, Jeeva G. Median and paramedian approach for spinal anaesthesia for caesarean delivery : A comparative analysis of safety and effectiveness. Indian J Clin Anaesth. 2017;4(4):518-22.

Singh P, Agrawal S, Dwivedi S, Yadav A. A comparative evaluation between median and paramedian approaches for sub-arachnoid block in elderly patients. Int J Res Med Sci. 2016;4(6):2069-72. https://doi.org/10.18203/2320-6012.ijrms20161762 DOI: https://doi.org/10.18203/2320-6012.ijrms20161762

Dadkhah P, Hashemi M, Gharaei B, Bigdeli MH, Solhpour A. Comparison of Post-spinal Back Pain After Midline Versus Paramedian Approaches for Urologic Surgeries. Available from: https://asja.springeropen.com/articles/10.1186/s42077-020-00088-5. [Last accessed on 2021 Apr 22]. https://doi.org/10.1186/s42077-020-00088-5 DOI: https://doi.org/10.1186/s42077-020-00088-5

Blomberg RG, Jaanivald A, Walther S. Advantages of the paramedian approach for lumbar epidural analgesia with catheter technique: A clinical comparison between midline and paramedian approaches. Anaesthesia. 1989;44(9):742-6. https://doi.org/10.1111/j.1365-2044.1989.tb09260.x PMid:2478045 DOI: https://doi.org/10.1111/j.1365-2044.1989.tb09260.x