1
|
Lakhe G, Shrestha P, Duwadi V. Postdural Puncture Headache after Spinal Anaesthesia in Parturients Undergoing Cesarean Section in the Department of Anesthesia in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2023; 61:417-420. [PMID: 37203905 PMCID: PMC10896439 DOI: 10.31729/jnma.8140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction The post-dural puncture headache is one of the common complications of spinal anaesthesia. It is one of the most frequent claims for malpractice involving obstetrics anaesthesia. Though self-limiting it is troublesome to the patient. The aim of this study was to find out the prevalence of post-dural puncture headache after spinal anaesthesia in parturients undergoing cesarean section in the Department of Anesthesia in a tertiary care centre. Methods A descriptive cross-sectional study was done among parturients who underwent cesarean section under spinal anaesthesia from 27 June 2022 to 19 January 2023 after receiving ethical approval from the Institutional Review Committee (Reference number: MEMG/480/IRC). The pregnant patients aged 18-45 years of the American Society of Anesthesiologists Physical Status II/IIE who underwent elective or emergency cesarean section under spinal anaesthesia were included. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among 385 parturients, the prevalence of post-dural puncture headache was 27 (7.01%) (4.53-9.67, 95% Confidence Interval). A total of 12 (44.44%) cases experienced post-dural puncture headache in the first 24 hours followed by 9 (33.33%) and 6 (22.22%) cases in 48 and 72 hours respectively. Moderate pain was complained of by 3 (11.11%) and 2 (7.41%) cases at 48 and 72 hours post-cesarean section respectively. Conclusions The prevalence of post-dural puncture headache after spinal anaesthesia in parturients undergoing cesarean section was similar to studies done in similar settings. Keywords cesarean section; headache; prevalence.
Collapse
Affiliation(s)
- Gajal Lakhe
- Department of Anesthesia, Manipal College of Medical Sciences, Fulbari, Pokhara, Nepal
| | - Pravin Shrestha
- Department of Obstetrics and Gynaecology, Manipal College of Medical Sciences, Fulbari, Pokhara, Nepal
| | - Vijaya Duwadi
- Manipal College of Medical Sciences Fulbari, Pokhara, Nepal
| |
Collapse
|
2
|
Kim JE, Kim SH, Han RJW, Kang MH, Kim JH. Postdural Puncture Headache Related to Procedure: Incidence and Risk Factors After Neuraxial Anesthesia and Spinal Procedures. PAIN MEDICINE 2021; 22:1420-1425. [PMID: 33675230 DOI: 10.1093/pm/pnaa437] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Postdural puncture headache (PDPH) is a potential complication of certain neuraxial anesthesia and spinal procedures, and some risk factors for PDPH have been identified. However, there have been no detailed analyses of rates and risk factors of PDPH after various spinal and neuraxial anesthesia procedures. METHODS Patient data from January 1, 2015, to December 31, 2017, were retrospectively analyzed. The patients underwent dural puncture procedures (spinal anesthesia, lumbar puncture [spinal tap], lumbar cerebrospinal fluid [CSF] drainage) or nondural puncture procedures (transforaminal epidural injection, interlaminar epidural injection, epidural catheterization with patient-controlled analgesia for delivery). PDPH incidence and risk factors were evaluated. RESULTS For dural puncture procedures, PDPH incidence was 2.96%, and risk factors were younger age, female sex, and lumbar puncture. Larger needle gauge was a risk factor according to Student t-test but not during logistic regression analysis. PDPH incidence was higher after lumbar puncture using a 22 G Tuohy needle (4.63%) than after lumbar CSF drainage using an 18 G Tuohy needle (3.05%). For nondural puncture procedures, PDPH incidence was 0.53% and did not differ between procedure types; no risk factors were identified. CONCLUSIONS PDPH incidence and risk factors depended on the type of neuraxial anesthesia and spinal procedures. PDPH incidence after lumbar puncture using a 22 G Tuohy needle was higher than that after lumbar CSF drainage using an 18 G Tuohy needle, suggesting that catheter insertion may reduce PDPH risk. In non-dural puncture procedures, PDPH risk did not differ according to type of procedure, and no risk factors were found.
Collapse
Affiliation(s)
- Jung Eun Kim
- Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | | | | | | | | |
Collapse
|
3
|
Shahriari A, Nataj-Majd M, Khooshideh M, Salehi-Vaziri S. The comparison of post-dural puncture headache treatment with acetaminophen-caffeine capsule and intravenous mannitol infusion: A randomized single-blind clinical trial. CURRENT JOURNAL OF NEUROLOGY 2021; 20:95-101. [PMID: 38011456 PMCID: PMC8743175 DOI: 10.18502/cjn.v20i2.6745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/04/2021] [Indexed: 12/05/2022]
Abstract
Background: Post-dural puncture headache (PDPH) is a common problem after spinal anesthesia. Depending on the severity of PDPH, there are both invasive and non-invasive treatments. Caffeine has been used for the treatment of PDPH since 1949, but the administration of mannitol is a novel management to tackle PDPH. This study was conducted to compare the effectiveness of acetaminophen-caffeine and mannitol in the treatment of PDPH. Methods: We enrolled 80 patients with PDPH in the present clinical trial and observed them during 72 hours after cesarean section. Participants were randomly and equally allocated to two groups for treatment with intravenous (IV) mannitol or oral acetaminophen-caffeine. The effects of treatment were evaluated using the visual analogue scale (VAS) questionnaire at hours of 1, 2, 3, 4, 6, 12, 18, 24, and 48. SPSS software was used. Results: Forty patients in each group completed the study. There was a significant reduction in the pain scores of the both groups after treatment, but the interaction between time and group demonstrated that mannitol administration was superior to acetaminophen-caffeine in pain reduction of the patients undergoing spinal anesthesia (P = 0.028). Patients' satisfaction in the mannitol group was significantly higher than the caffeine group (P = 0.001). Conclusion: This study suggests that IV mannitol infusion affects faster and earlier for the treatment of PDPH than acetaminophen-caffeine capsule. Mannitol could be probably more effective for treatment of PDPH.
Collapse
Affiliation(s)
- Ali Shahriari
- Department of Anesthesiology, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Nataj-Majd
- Department of Anesthesiology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Khooshideh
- Research Development Center, Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Salehi-Vaziri
- Research Development Center, Department of Obstetrics and Gynecology, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Kim A, Lim D, Piatt J. Low-pressure CSF shunt malfunction without preceding lumbar puncture treated by epidural blood patch: report of 2 cases. Childs Nerv Syst 2021; 37:973-976. [PMID: 33447856 DOI: 10.1007/s00381-020-04996-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022]
Abstract
Low-pressure CSF shunt malfunction is a poorly understood complication of hydrocephalus affecting patients of all ages. Treatment commonly requires external drainage of CSF to subatmospheric pressures for days to weeks in an intensive care setting. The current communication describes the repurposing of an established therapeutic technique, epidural blood patch, for successful initial management in 2 cases of low-pressure shunt malfunction in the absence of a recognized spinal CSF fistula. This technique may shorten length of stay and obviate potential morbidity in the management of what is otherwise a vexatious clinical problem.
Collapse
Affiliation(s)
- Adeline Kim
- Department of Anesthesia, Nemours / A I duPont Hospital for Children, Wilmington, DE, USA
- Departments of Anesthesia, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
- Department of Anesthesiology, Loma Linda University Medical Center, Redlands, CA, USA
| | - Doyle Lim
- Department of Anesthesia, Nemours / A I duPont Hospital for Children, Wilmington, DE, USA
- Departments of Anesthesia, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph Piatt
- Division of Neurosurgery, Nemours / A I duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
- Departments of Neurological Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
- Departments of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| |
Collapse
|
5
|
Ljubisavljevic S. Postdural puncture headache as a complication of lumbar puncture: clinical manifestations, pathophysiology, and treatment. Neurol Sci 2020; 41:3563-3568. [PMID: 32997283 DOI: 10.1007/s10072-020-04757-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/23/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This manuscript is a narrative review of peer-reviewed studies of postdural puncture headache (PDPH) as the most common complication of a diagnostic and therapeutic lumbar puncture (LP) and LP due to the damage of the dura mater in epidural anesthesia. METHODS Author searched articles related to the PDPH and its risk factors, pathophysiology diagnosis, differential diagnosis, and therapy. All studies according to the analyzed parameters and their relevance to the clinical practice, as well as quality of the study methods, were selected for further analysis. RESULTS The review presents the clinical and paraclinical prediction criteria for the onset, clinical features, course, and efficiency of specific therapeutic interventions which are of a particular clinical benefit for the prevention, pathogenetic treatment, and differential diagnosis of PDPH. The analysis of prediction parameters for the onset, clinical course, and associated symptoms and signs of PDPH is a contribution to the understanding of pathophysiology of intracranial hypotension, since PDPH can be considered a clinical model of intracranial hypotension. CONCLUSIONS Given that LP is a common procedure in clinical practice, it is necessary to have a comprehensive knowledge of the risk factors, pathophysiological, diagnostic, differentially diagnostic, and therapeutic aspects of PDPH.
Collapse
Affiliation(s)
- Srdjan Ljubisavljevic
- Department for Neurology, Faculty of Medicine, University of Nis, Nis, Serbia. .,Department for Cerebrovascular Diseases and Headache, Clinic for Neurology, Clinical Center of Nis, Blvd. Dr Zorana Djindjica 81, Nis, 18000, Serbia.
| |
Collapse
|
6
|
Ljubisavljevic S, Zidverc Trajkovic J. Postdural puncture headache leads to clinical worsening of pre-existing chronic headache. J Clin Neurosci 2020; 75:30-34. [PMID: 32223975 DOI: 10.1016/j.jocn.2020.03.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 03/03/2020] [Accepted: 03/20/2020] [Indexed: 12/16/2022]
Abstract
The incidence of postdural puncture headache (PDPH) in relation to pre-existing chronic headache (CH) was assessed, as was the clinical course of CH, at one, three, and six months after PDPH. The study was conducted as a single center cohort prospective study that included 252 patients (105 men and 147 women), average age of 47.3 ± 15.0 years, on whom lumbar puncture (LP) was performed. PDPH was reported in 133 (52.8%) patients; CH was reported in 82 (32.5%) patients. Patients with CH were more likely to have PDPH (p = 0.003). The individual clinical type of CH did not have an effect on the incidence of PDPH (p = 0.128). Patients with PDPH had a clinical deterioration of CH three and six months after LP (p = 0.047, p = 0.027, respectively) in terms of increased headache days per month and/or incomplete efficacy of performed therapy in relation to baseline values. Six months after LP, the worsening of CH was more common in women with PDPH (OR 5,687 [95% CI: 1526-21,200], p = 0.010) and patients with a longer history of CH (OR 1064 [95% CI: 1007-1124], p = 0.027). Multivariate analysis confirmed the direct association of female sex and duration of CH and its worsening six months after PDPH (OR 4478 [95% CI: 1149-17,452], p = 0.031; OR 1448 [95% CI: 1292-1808], p = 0.022). The presented results could be significant for the prediction/differential diagnosis of PDPH in patients with CH and for the prediction/prevention of CH clinical worsening after PDPH.
Collapse
Affiliation(s)
- Srdjan Ljubisavljevic
- Faculty of Medicine, University of Niš, Clinic for Neurology, Clinical Center of Niš, Niš, Serbia.
| | - Jasna Zidverc Trajkovic
- Faculty of Medicine, University of Belgrade, Clinic for Neurology, Clinical Center of Serbia, Belgrade, Serbia
| |
Collapse
|
7
|
Botros JM, Sayed AM. Comparison between the Effects of Sumatriptan Versus Naratriptan in the Treatment of Postdural Puncture Headache in Obstetric Patients: A Randomized Controlled Trial. Anesth Essays Res 2019; 13:376-382. [PMID: 31198263 PMCID: PMC6545953 DOI: 10.4103/aer.aer_17_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Postdural puncture headache (PDPH) in the obstetric anesthesia practice is one of the most annoying, common, and important problems. AIM This comparative study was designed to assess the efficacy of naratriptan in relieving PDPH in parturients who gave birth by cesarean section under intrathecal anesthesia and to compare its efficacy with sumatriptan. SETTINGS AND DESIGN One hundred and eighty-nine adult parturients who complained of PDPH in the first 3 days postpartum period were enrolled in this study. They were divided into three equal parallel groups of 63 each. MATERIALS AND METHODS Group-1 controlled (C-group) received multivitamin tablets, Group-2 sumatriptan (S-group) received sumatriptan tablets and Group-3 naratriptan (N-group) received naratriptan tablets. The efficacy of naratriptan in relieving PDPH was studied and compared with that of sumatriptan. Incidences of complications of both drugs were also noted. STATISTICAL ANALYSIS The collected data were organized, tabulated, and statistically analyzed using SPSS software statistical computer package version 18 (SPSS Inc., USA). RESULTS After the first 6 h, there were statistically significant differences between Groups S and N from one side and control group from the other side (P < 0.0001 and 0.001), respectively, and the difference between Group S and Group N was statistically significant (P = 0.004). After 12 h, there were statistically significant differences between Groups S and N from one side and the control group from the other side (P < 0.0001) and the difference between Group S and Group N was statistically significant (P = 0.002). After 72 h, there were statistically significant differences between Groups S and N from one side and control group from the other side (P < 0.001 and 0.009), respectively. The difference was nonsignificant between S and N group (P = 0.717). CONCLUSION The study revealed that anti-migraine drug naratriptan in combination with supportive treatment was effective in relieving PDPH in parturients.
Collapse
Affiliation(s)
- Joseph Makram Botros
- Department of Anaesthesia, Pain Management, and Intensive Care, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Atef Mohammed Sayed
- Department of Anaesthesia, Pain Management, and Intensive Care, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| |
Collapse
|
8
|
Sezaryen geçiren hastalarda intratekal enjeksiyon hızının post-dural ponksiyon baş ağrısı üzerine etkisi: Prospektif, Randomize Çalışma. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/gopctd.472003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
9
|
Park S, Kim K, Park M, Lee U, Sim HS, Shin IS, Song Y. Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis. Pain Manag Nurs 2017; 19:267-276. [PMID: 29269181 DOI: 10.1016/j.pmn.2017.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/28/2017] [Accepted: 10/09/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES We performed a systematic review of the evidence for the effectiveness of bed rest after dural puncture to update current evidence on the topic. DESIGN The design was a systematic review and meta-analysis. DATA SOURCES We searched 10 electronic databases in English (Medline, CINAHL, EMBASE, and the Cochrane Controlled Trial Register) and Korean (KISS, KMBASE, NDSL, and RISS) using the terms "post-dural puncture headache," "spinal anesthesia," "epidural anesthesia," and "bed rest" to identify reports discussing the effectiveness of bed rest in preventing post-dural puncture headache (PDPH) after spinal anesthesia from 1980 to 2014. Review/Analysis Methods: Original studies such as randomized and nonrandomized controlled trials, where participants were allocated to an intervention or control group, were included. A total of eight studies that met the inclusion criteria were independently reviewed and encoded by two review authors. To ensure the quality of the eight studies, levels of risk of bias were assessed by two different researchers. The main outcome was the prevalence of PDPH. RESULTS The included studies indicated that PDPH prevalence did not differ between the group assigned to 24 hours of bed rest and the group assigned to early ambulation. In subgroup analysis, the effect size of clinical factors (severity of headache, day of onset, and needle gauge) and the study characteristics (language and sample size) did not differ between groups. CONCLUSION This meta-analysis of studies suggested that long-term bed rest after spinal anesthesia may not be effective in preventing PDPH.
Collapse
Affiliation(s)
- Seyeon Park
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Kyoungok Kim
- Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Myouyun Park
- Department of Nursing, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Ukyoung Lee
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea
| | - Hee-Sook Sim
- Department of Nursing, Pai Chai University, Daejeon, Republic of Korea
| | - In-Soo Shin
- Department of Education, Jeon-Ju University, Jellabukdo, Republic of Korea
| | - Youngshin Song
- College of Nursing, Chungnam National University, Daejeon, Republic of Korea.
| |
Collapse
|
10
|
Gupta S, Mehta N, Mahajan A, Dar MR, Gupta N. Role of Oral Prednisolone in the Management of Postdural Puncture Headache after Spinal Anesthesia in Urological Patients. Anesth Essays Res 2017; 11:1075-1078. [PMID: 29284878 PMCID: PMC5735453 DOI: 10.4103/0259-1162.183565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Postdural puncture headache (PDPH) is a frequently encountered complication of spinal anesthesia and may be associated with significant morbidity in some patients. Parenteral corticosteroids have been used in the management of PDPH both prophylactically and after the occurrence of headache. The aim of this study was to evaluate the effect of oral prednisolone in the management of PDPH after spinal anesthesia in urological patients. MATERIALS AND METHODS Sixty adult patients who developed PDPH after spinal anesthesia for urological surgeries were randomly allocated to two groups. Group C patients (n = 30) were managed conservatively, and Group P patients (n = 30) were given 20 mg of oral prednisolone for 4 days in addition to the conventional treatment. The intensity of headache was measured using visual analog scale (VAS). VAS score was taken just before the start of treatment (0 h) and at 12, 24, 48, 72, and 96 h after the start of treatment. STATISTICAL ANALYSIS Statistical analysis was performed using Statistical Packages for Social Science version 19 (SPSS, Inc., Chicago, IL, USA). RESULTS There was no statistically significant difference in the VAS score in patients before the start of treatment (0 h) and at 12 h after the start of treatment. The VAS scores were less and statistically significant in Group P at 24, 48, 72 and 96 h after the start of treatment (P < 0.05). CONCLUSION The use of oral prednisolone is effective in reducing the severity and duration of PDPH.
Collapse
Affiliation(s)
- Sunana Gupta
- Department of Anaesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu, Jammu and Kashmir, India
| | - Nandita Mehta
- Department of Anaesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu, Jammu and Kashmir, India
| | - Arti Mahajan
- Government Medical College and Hospital, Jammu, Jammu and Kashmir, India
| | - Mohd Reidwan Dar
- Department of Anaesthesiology and Intensive Care, Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Katra, Jammu, Jammu and Kashmir, India
| | | |
Collapse
|
11
|
Davoudi M, Tarbiat M, Ebadian MR, Hajian P. Effect of Position During Spinal Anesthesia on Postdural Puncture Headache After Cesarean Section: A Prospective, Single-Blind Randomized Clinical Trial. Anesth Pain Med 2016; 6:e35486. [PMID: 27843773 PMCID: PMC5100205 DOI: 10.5812/aapm.35486] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/30/2016] [Accepted: 06/05/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The most common method of anesthesia for cesarean section is spinal anesthesia, and postdural puncture headache (PDPH) remains a major complication of this procedure. Nowadays, PDPH is a major cause of morbidity in parturients after spinal anesthesia. This headache is the third most popular reason for claims against anesthesiologists in obstetrics. The position after spinal anesthesia has been evaluated as a contributory factor in the occurrence of PDPH, but the position before spinal anesthesia has not yet been evaluated. OBJECTIVES This study was designed to compare the incidence of PDPH following spinal anesthesia in the sitting position and in the left lateral decubitus position in parturients who underwent elective caesarian section. PATIENTS AND METHODS After institutional approval, 100 parturients who had been scheduled for elective caesarian section with spinal anesthesia were enrolled in the study. Following patient preparation for the neuraxial blockade, spinal anesthesia was randomly performed in the sitting or in the left lateral decubitus position. Patients were interviewed for PDPH on either postoperative day one, two, or three. The incidence and intensity of PDPH were evaluated and compared using a numeric rating scale (NRS-11). RESULTS A total of 94 patients were included in the data analysis. The overall incidence of PDPH was 12.7%. In the sitting group, ten patients (20.8%) had PDPH, compared with two patients (4.3%) in the lateral group (P = 0.017). CONCLUSIONS Spinal anesthesia in the sitting position is more associated with significant PHDH than that in the left lateral decubitus position for patients undergoing elective caesarian section.
Collapse
Affiliation(s)
- Maryam Davoudi
- Department of Anesthesia, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Masoud Tarbiat
- Department of Anesthesia, Hamedan University of Medical Sciences, Hamedan, Iran
- Corresponding author: Masoud Tarbiat, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamedan, Iran. Tel: +98-9186763224, Fax: +98-81338280096, E-mail:
| | | | - Puran Hajian
- Department of Anesthesia, Hamedan University of Medical Sciences, Hamedan, Iran
| |
Collapse
|
12
|
Mahoori A, Noroozinia H, Hasani E, Saghaleini H. Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache. Saudi J Anaesth 2014; 8:374-7. [PMID: 25191190 PMCID: PMC4141388 DOI: 10.4103/1658-354x.136436] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Post-dural puncture headache (PDPH) is a common complication of lumbar puncture for any purpose. To avoid the need for invasive methods of treating PDPH such as blood patch, the search for novel pharmacological agents to manage PDPH continues. The aim of this study was to compare the effects of acetaminophen, gabapentin and pregabalin in controlling PDPH in patients who underwent surgery under spinal anesthesia. Materials and Methods: A total of 90 patients who underwent elective orthopedic surgery under spinal anesthesia and suffered from PDPH consequently were enrolled in this randomized trial. Patients were categorized randomly into three groups. Group A, B and C have received Acetaminophen, Gabapentin and Pregabalin (3 times a day for 3 days), respectively. The effect of medications on the severity of PDPH was evaluated and compared using visual analog scale (VAS). Results: The mean VAS score was significantly lower in pregabalin group compared with others 24, 48 and 72 h after the onset of headache (P = 0.001 for all of them) and lower in Gabapentin group compared with Acetaminophen group 24, 48 and 72 h after the onset of headache (P = 0.001 for all analyses). No adverse outcome was reported in groups. Conclusion: Pregabalin and gabapentin are both useful and safe in management of PDPH, but pregabalin is more effective in this regard.
Collapse
Affiliation(s)
- Alireza Mahoori
- Department of Anesthesiology and Pain Medicine, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Heydar Noroozinia
- Department of Anesthesiology and Pain Medicine, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Ebrahim Hasani
- Department of Anesthesiology and Pain Medicine, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Hadi Saghaleini
- Department of Anesthesiology and Pain Medicine, Imam Khomeini Training Hospital, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
13
|
The influence of timing on the effectiveness of epidural blood patches in parturients. Int J Obstet Anesth 2013; 22:303-9. [DOI: 10.1016/j.ijoa.2013.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 04/19/2013] [Accepted: 04/30/2013] [Indexed: 11/20/2022]
|
14
|
Matas SLDA. Why should we use atraumatic needles in lumbar puncture? ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:681-4. [DOI: 10.1590/0004-282x20130150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diagnostic lumbar puncture is essential to the diagnosis of central nervous system infections, subarachnoid haemorrhage and others neurological diseases. Myeloradicular involvement or life-threatening adverse events due to the procedure are rare, but less severe complications are more frequent. Post-lumbar puncture headache is the most common complication, by spinal fluid leakage due to delayed closure of a dural defect. Therefore, the development of fine needles, with differentiated atraumatic bevel, has contributed to minimize that problem. These generically called atraumatic needles cause less deformation of the dura mater then the Quincke® ones. So, why don't we use these atraumatic needles?
Collapse
|
15
|
Gonen KA, Taskapilioglu O, Dusak A, Hakyemez B. Persistent headache in a postpartum patient: the investigation and management. BMJ Case Rep 2013; 2013:bcr-2013-009931. [PMID: 23813512 DOI: 10.1136/bcr-2013-009931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Postdural puncture headache (PDPH) is the most common complication of obstetric regional anaesthesia and the most likely cause of headache in a woman who underwent epidural anaesthesia during delivery. Cerebral venous sinus thrombosis (CVST) is an uncommon cause of postpartum headache. Anaesthesia in obstetrics may lead to long-lasting intracranial hypotension resulting in CVST. CVST is a serious pathology with high mortality if misdiagnosed, but its correct and rapid diagnosis offers the opportunity for early treatment. Cranial magnetic resonance imaging (MRI) is an important modality in the diagnosis of both CVST and intracranial hypotension. The latter condition may be treated either by an epidural blood patch or bed rest and hydration. We report a case of a 36-year-old woman who developed CVST and multiple venous infarcts after an attempted epidural procedure during delivery. She was treated conservatively with bed rest, hydration and low-molecular-weight heparin and the patient recovered completely.
Collapse
Affiliation(s)
- Korcan Aysun Gonen
- Department of Radiology, Namik Kemal University, School of Medicine, Tekirdag, Turkey.
| | | | | | | |
Collapse
|
16
|
Abstract
First reported in 1898, post-dural puncture headache (PDPH) remains a significant clinical issue. Here, we present a brief case history and a summary of the current evidence for methods to reduce PDPH rates, along with the experience in our department of implementing these methods in clinical practice. The key points to note are that needle design, gauge and orientation, as well as stylet reinsertion, are factors known to affect the incidence of PDPH, and that there is no evidence to support the use of hydration and bed rest to reduce headache following dural puncture.
Collapse
Affiliation(s)
- Sara Waise
- Emergency Assessement Unit, Colchester University Hospital Foundation Trust, Colchester, UK.
| | | |
Collapse
|
17
|
Abstract
A serum agglutinin reactive with red cells in the presence of polycarboxyl groups is reported. It is likely that this represents an additional example of the type of agglutinin previously described as agglutinating red cells in the absence of ionized calcium. Experimental evidence is presented indicating that it is free polycarboxyl groups that potentiate agglutination and that any metal ion, such as calcium, capable of chelating with these groups will prove to be inhibitory.
Collapse
|