بررسی درد محل تزریق، کمردرد و رضایت بیماران از تکنیک اپیدورال در دو روش مدین و پارامدین

Background and purpose: Median epidural block is often done with some difficulty due to pain, ossification of interspinous ligament and improper positioning of patient. Ïn addition, back pain is common with median approach, that may be due to puncture of ligaments on the line of epidural needle passage. Ïn paramedian approach needle dose not pass through ligaments, so back pain can be theoretically less. Materials and methods: Ïn a single blind clinical trial, pain at needle insertion point, back pain and satisfaction of patient from epidural technique at the time of operation and in ward, in addition, pain score at three phases in median (20 patients) and paramedian (20 patients) groups were studied. Ëpidural block was done at sitting position and hanging drop maneuver was used for all the patients. Severity of pain with the help of pain score and comparison of pain with the pain arised due to insertion of angiocath insertion on the back of hand were evaluated (p<0.05). Results : Ïn this study, it was found that pain at the point of insertion (compared to the pain by angiocath at the back of hand) in paramedian group was less (12 cases of less pain in paramedian group versus 12 cases of severe pain in median group). Ïn paramedian group less back pain was noticed. Âlso statisfaction of patients with epidural approach was more in paramedian group (50% in paramedian group versus 20% in median group). Ïn all of the three cases, there were significant differences between median and paramedian groups. Çonclusion: Referring to the results of this study, it is concluded that comparing to the median paramedian approach is followed with more satisfaction, with less pain approach and is easier too particularly when due to pain or ossification of ligaments proper positioning of the patient for median approach in not possible.