scholarly journals Efficacy and Safety of Prophylactic Intrathecal Normal Saline for Prevention of Post Dural Puncture Headache among Women Undergoing Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Semagn Abate ◽  
Siraj Ahmed ◽  
Getachew Mergia Anbese
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Normal Saline ◽  
Dural Puncture ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Repeated Measurements ◽  
Epidural Needle ◽  
Post Dural Puncture Headache ◽  
Resource Limited

Abstract Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body of evidence revealed that Conservative management failed to show significant benefit and epidural needle and catheter techniques didn’t provide conclusive evidence. On the other hand, intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety profiles.Methods and materials: After Obtaining Ethical clearance from IRB, 152 mothers scheduled for cesarean section under spinal anesthesia were allocated randomly into two groups. Data analysis was done with SPSS version 22. Descriptive statistics were run to see the overall distribution of the study subjects. Unpaired student’s T-test for continuous symmetric data and Mann-Whitney U test for non-normally distributed data were used. Categorical data were analyzed with Chi-square and fisher’s exact test where appropriate. A generalized estimating equation model was used to investigate the interaction of repeated measurements of NRS pain scores of PDPH. Result: The overall incidence of PDPH was 29.6% while the proportion of patients who experienced PDPH was the highest among patients with control as compared to intervention( 36.8% vs 22%) respectively. The GEE model revealed that the NRS pain score was 0.7, 0.4, and 0.2 unit higher at 12, 24, and 48 respectively in control as compared to the interventionConclusion: prophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasibleRegistration: The protocol was registered prospectively in Clinical Trials.gov (NCT04393766).

scholarly journals Suboccipital Muscles Injection for Management of Post-Dural Puncture Headache After Cesarean Delivery: A Randomized-Controlled Trial

2019 ◽  
Vol 7 (4) ◽  
pp. 549-552 ◽  
Author(s):  
Mhamed Abdelraouf ◽  
Maged Salah ◽  
Mohsen Waheb ◽  
Ahmed Elshall
Keyword(s):  
Cesarean Section ◽  
Dural Puncture ◽  
Controlled Trial ◽  
Demographic Data ◽  
Visual Analogue Score ◽  
Control Group ◽  
Neck Muscle ◽  
Rescue Analgesia ◽  
Post Dural Puncture Headache ◽  
Control Group Group

INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay. AIM: This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section. PATIENT AND METHODS: A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). All patients received bilateral intramuscular (in the suboccipital muscle) (Group S) (n = 45) patients received lidocaine 40 mg (2 mL of 2% solution) and dexamethasone 8mg in a total volume of 4 mL; whilst, patients in the control group (group C) (n = 45) received 4 mL normal saline. The primary outcome is the Visual Analogue Score for a headache at 24 hours after injection. RESULTS: Demographic data and the baseline, headache score, neck muscle spasm, and nausea were comparable in both groups. Group S showed lower headache score compared to group C at all the post-injection time points. All patients in group S showed resolution of nausea after the intervention; while none of the control group showed any improvement. All patients of group C needed rescue analgesia; while only 6 (13.3%) patients in group S asked for an analgesic. Time to the first analgesic request was longer in group S compared to group C (10.17 ± 7.96 hours versus 1.00 ± 0.00 hours, P < 0.001). CONCLUSION: Ultrasound-guided injection of the dexamethasone-lidocaine mixture in suboccipital muscles is effective management of PDPH after CS.

scholarly journals Comparison of the effects of sagittal versus transvers 25-gauge quincke needle insertion on post-dural puncture headache development

2020 ◽  
Vol 7 (7) ◽  
pp. 554-559
Author(s):  
Mehmet Tercan ◽  
Tuğba Bingöl Tanrıverdi ◽  
Gülçin Patmano ◽  
Ahmet Atlas ◽  
Ahmet Kaya ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Dura Mater ◽  
Dural Puncture ◽  
Multivariate Logistic Regression Analysis ◽  
Needle Insertion ◽  
Spinal Needle ◽  
Post Dural Puncture Headache ◽  
Spinal Puncture ◽  
American Society

Objective: Post-dural puncture headache (PDPH) is one of the most important complications after spinal anesthesia. This study aimed to investigate the effect of the sagittal or transverse application of 25-gauge Quincke spinal needle on PDPH development in patients undergoing cesarean section. Material and Methods: A total of 295 patients with a planned cesarean section between the ages of 18-40 years with an American Society of Anesthesiologists score of 1 or 2 were included in the study. For the spinal intervention, 25-gauge Quincke spinal needle was used in all patients. Patients were included in one of two groups according to the spinal needle cutting direction of the dura mater fibers as sagittal (parallel to dura mater fibers, Group S; n=145) or transverse group (perpendicular to dura mater fibers, Group T; n=150). Results: PDPH developed in 27 (9.2%) patients. Patients in Group T had significant higher ratio of PDPH compared to patients in Group S (16% vs. 2.1%, p<0.001). Additionally, patients with PDPH had a significantly higher frequency of ≥2 spinal puncture attempts compared to patients without PDPH (22.2% vs. 4.5%, p=0.003). Multivariate logistic regression analysis demonstrated that transverse needle direction (OR: 11.40, 95% CI: 2.73-34.71; p<0.001) and ≥2 spinal puncture attempts (OR: 9.73, 95% CI: 3.13-41.55; p<0.001) and were independent predictors for PDPH development. Conclusion: Transverse insertion of the 25-gauge Quincke needle into spinal cord fibers and repeated interventions are independently associated with the development of PDPH in cesarean section patients undergoing spinal anesthesia

scholarly journals Post Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E871-E876
Author(s):  
Khalid M. Morsy
Keyword(s):  
Chronic Pain ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Dural Puncture ◽  
Control Group ◽  
Elective Cesarean Delivery ◽  
Post Dural Puncture Headache ◽  
Elective Cesarean ◽  
Control Study

Background: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they have enhanced central nervous system sensitization and decreased descending inhibition. Objective: The current study aims to verify the incidence and chronicity of PDPH in FMS patients. Study Design: Case control study. Methods: In a comparative control study, 70 fibromyalgia patients were scheduled for an elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 women scheduled for elective cesarean delivery who had no history of chronic pain and is used as a control group. Both groups were compared regarding the incidence of development of PDPH in the first postoperative 48 hours and the persistence of PDPH for 7 days or more. Settings: Women’s Health Hospital, Assiut University, antenatal Clinic. Results: The fibromyalgia group reported more PDPH (18 patients, 25.7%) as compared to the control group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patients in the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPH continued for more than 3 months in 2 patients in the fibromyalgia group (2.86%) Limitations: Difficulty in calculating the dose of analgesics as patients with fibromyalgia may use other analgesics due to musculoskeletal pain. Conclusion: Dural puncture increases the incidence of PDPH in fibromyalgia patients in comparison with normal controls without increasing other postoperative side effects. Key Words: Fibromyalgia, cesarean section, post dural puncture headache, spinal anesthesia

scholarly journals A Case of Post-partum Chronic Subdural Hematoma.

2021 ◽  
Author(s):  
Suyasha Rajbhandari ◽  
Pritam Gurung ◽  
Gopi Nepal ◽  
Samir Acharya ◽  
Basant Pant
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Subdural Hematoma ◽  
Dural Puncture ◽  
Post Partum ◽  
Chronic Subdural Hematoma ◽  
Lower Segment ◽  
Post Dural Puncture Headache ◽  
Lower Segment Cesarean Section ◽  
Variable Presentation

Intracranial subdural hematoma following spinal anesthesia is an infrequent occurrence and has variable presentation. Due to rarity, it may often be misdiagnosed as post-dural puncture headache. In this report, we describe a case of a 25-year-old woman who presented with a headache following lower segment cesarean section after spinal anesthesia.

Comparison between Nalbuphine and Ketamine as an adjuvant to Heavy Bupivacaine on Post Dural Puncture Headache

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammad A El Gendy ◽  
Gamal M Elewa ◽  
Mina Z Wadea ◽  
Ashraf M Hazem
Keyword(s):  
Spinal Anesthesia ◽  
Normal Saline ◽  
Dural Puncture ◽  
Sensory Block ◽  
Saline Group ◽  
Controlled Study ◽  
Normal Saline Group ◽  
Hyperbaric Bupivacaine ◽  
Post Dural Puncture Headache ◽  
Significant Difference

Abstract Background Incidence of post dural puncture headache (PDPH) is relatively high, and many methods have been tried to prevent or treat it, but results are not satisfactory. Both Nalbuphine and Ketamine have analgesic effects, and have been used intrathecally with local anesthetics, but their effects on PDPH were not studied. Objective To study the incidence and severity of PDPH when nalbuphine or ketamine was added as an adjuvant to hyperbaric bupivacaine in spinal anesthesia (primary outcome). Secondary outcomes were the effects of adding nalbuphine or ketamine as an adjuvant to hyperbaric bupivacaine on motor and sensory effects, duration of analgesia, hemodynamics and side effects of both of them. Patients and Methods This prospective double-blind, randomized controlled study was conducted on 320 patients, aged 21–60 years of both sexes, ASA physical status I and II, and allocated for lower abdominal, pelvic, or lower limb surgeries under spinal anesthesia, after approval from ethical committee (Assurance No. FWA 000017585) of Faculty of Medicine, Ain, Shams University, Cairo, Egypt. Contact with 17 patients was lost. So, 303 patients completed the study. Patients were divided into 3 equal groups (101 each) according to drugs injected intrayhecally. Group (N): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 mg nalbuphine hydrochloride diluted in 0.5 ml normal saline. Group (K): 3 ml of 0.5% hyperbaric bupivacaine with 25 mg ketamine hydrochloride diluted in 0.5 ml normal saline. Group (C): 3 ml of 0.5% hyperbaric bupivacaine with 0.5 ml normal saline. Results Incidence of PDPH was statistically significantly less in group N in comparison to Groups K and C, in the first day. But, no statistically significant difference was found between the three groups at 2nd and 3rd days. There was no statistically significant difference between groups according to severity of PDPH by visual analog score (VAS). Group N has the most rapid onset and long duration of sensory block in comparison with groups K and C. There was no statistically significant difference between groups according to onset and duration of motor block and hemodynamic changes. Conclusion Adding nalbuphine, and not ketamine, with hyperbaric bupivacaine in spinal anesthesia decreased incidence of post dural puncture headache, and prolonged the duration of sensory block. Both groups provided adequate anesthesia and analgesia with good hemodynamic stability.

POST-DURAL PUNCTURE HEADACHE AND RISK FACTORS IN WOMEN UNDERGOING CESAREAN SECTION WITH SPINAL ANESTHESIA

2019 ◽  
pp. 37-43
Author(s):  
Thi Minh Thu Pham ◽  
Thi Hoang Yen Do ◽  
Van Long Le ◽  
Van Minh Nguyen ◽  
Viet Ha Vo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Local Anesthesia ◽  
Dural Puncture ◽  
Insertion Site ◽  
Moderate Pain ◽  
Needle Size ◽  
Post Dural Puncture Headache ◽  
History Of

Objective: To estimate the incidence of post-dural puncture headache (PDPH) and risk factors in women underwent Cesarean section with spinal anesthesia. Materials and method: In a prospective descriptive study, parturients underwent Cesarean section with spinal anesthesia. Incidence of post-dural puncture headache, the history of spinal anesthesia and PDPH, presence of headache, preeclampsia, migraine, sinusitis, caffeine withdraw, insertion site, repeated puncture attempts, direction of the needle, size of the needle, local anesthesic, perioperative hypotension, nausea and vomiting, amount of intravenous fluid were recorded. Results: There were 389 patients in the study. The incidence of PDPH was 14.65% (mild and moderate pain: 75.44%; severe pain 21.05%; worst pain: 3.51%). The risk factors were history of PDPH (OR = 4.5; 95% CI: 1.8 - 11.09), sinusitis (OR = 2.65; 95% CI: 1.10 - 6.36), local anesthesia (Marcain spinal 0.5% heavy) (OR = 6.66; 95% CI: 2.25 - 19.11), perioperative hypotension (OR = 2.42; 95% CI: 1.25 - 4.70). Conclusion: The incident of PDPH in women undergoing Cesarean section with spinal anesthesia was 14.65%. Four risk factors were the history of PDPH, sinusitis, local anesthesia (Marcain spinal 0.5% heavy) and perioperative hypotension. Key words: post-dural puncture headache (PDPH), Cesarean section, spinal anesthesia

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