Haider S Z, Khalid J Butt, Aziz M A, Qasim M.
Post dural puncture headache - a comparison of midline and paramedian approaches.
Biomedica Jan ;21(2):90-2.

The purpose of this study was to compare two approaches for dural puncture regarding post dural puncture headache (PDPH) in general population presenting for surgery under spinal anaesthesia. A comparative observational study was conducted at Sir Gang a Ram Hospital, Lahore, from March 2005 to July 2005. Twenty five patients, planned to undergo elective surgery under spinal anaesthesia, were randomly assigned to each of the two groups. Group-M received sub arachnoid block (S.A.B.) using midline approach for dural puncture whereas in Group-P paramedian approach was utilized. Both groups were observed for PDPH for three post operative days. The PDPH was much less frequent in P group compared to M Group, thus it was concluded that paramedian approach should be used frequently for dural puncture for spinal anaesthesia.

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