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

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.