scholarly journals THE COMPLICATIONS OF SPINAL ANESTHESIA IN OBSTETRIC AND GYNECOLOGICAL SURGICAL PROCEDURES

2019 ◽  
Vol 17 (1) ◽  
pp. 2-5
Author(s):  
Deeba Kalim ◽  
Talat Saeed ◽  
Fauzia Anbreen
Keyword(s):  
Spinal Anesthesia ◽  
Surgical Procedures ◽  
Dural Puncture ◽  
Late Complications ◽  
Puncture Site ◽  
Post Dural Puncture Headache ◽  
Respiratory Problems ◽  
Severe Hypotension ◽  
Gynecological Surgical Procedures ◽  
Site Pain

Background: The proper use of spinal anesthesia in surgical procedures will minimize patient’s referral. The objectives of the study were to determine the immediate and late complications of spinal anesthesia in obstetric and gynecological surgical procedures in our population. Material and Methods: This cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Moulvi Ameer Shah Memorial Hospital, Peshawar, Pakistan from January 2014 to December 2014. Sample size was 790, selected through consecutive sampling technique. All routine and emergency obstetrical and gynecological cases were included. The exclusion criteria were those having hypotension, shock, coagulopathy, prolonged surgeries, patient’s refusal and local spinal disease. The demographic variables were; number of attempts, failure of anesthesia, vomiting, hypotension, respiratory problems, pain, Puncture site pain, and post dural puncture headache. All variables being categorical were analyzed by frequency and percentages using SPSS Version 16.0. Results: Out of 790 obstetrics and gynecology patients undergoing spinal anesthesia, there were 752 (95.2%) patients anaesthetized on first attempt whereas 38 (4.8%) required >1 attempts. Spinal anesthesia failed in 17 (2.1%) cases, partially failed in 15(1.9%). Post-operative mild hypotension was observed in 25 (3.1%) patients and severe hypotension in 4 (0.5%) cases. Respiratory problems were noted among 12 (1.9%). Patient’s Post-operative pain was observed in 28 (3.5%) patients. Nausea and vomiting were noted in 68 patients (8.6%).Late complications include post-operative mild to moderate pain in 65 (8.2%), severe in 15 (1.9%). Puncture site pain was observed in 8 (1.0%) of patients. Severe post dural puncture headache was noted in 3 (.38%). Conclusion: Spinal anesthesia in obstetric and gynecological surgical patients is easy to administer, safer and effective.

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 Incidence of post dural puncture headache in parturients following early ambulation and recumbency

2017 ◽  
Vol 4 (2) ◽  
pp. 14-20
Author(s):  
Niroj Hirachan
Keyword(s):  
Caesarean Section ◽  
Spinal Anesthesia ◽  
Dural Puncture ◽  
Muscle Relaxation ◽  
Early Mobilization ◽  
Chi Square ◽  
Early Ambulation ◽  
Post Dural Puncture Headache ◽  
Chi Square Test ◽  
Group A

Introductions: Spinal anesthesia is a safe and acceptable technique for patients undergoing caesarean section because it provides both excellent analgesia and muscle relaxation. Post Dural Puncture Headache (PDPH) is frequently reported complication after spinal anesthesia. This study evaluates the incidence of PDPH following early mobilization and recumbency after caesarean section. Methods: This prospective, randomized comparative interventional study included 100 parturients women of age 18 to 45 years, ASA I and II, randomly divided into two groups – Ambulatory ‘A’ and Recumbent ‘R’. At the end of caesarean section, patients were advised to either lie in recumbent position for 24 hours or mobilize as soon as they become ambulatory after spinal aneshthesia. Occurrence of headache were recorded at 24 hours, 72 hours and 7th day. Software SPSS 16, chi-square test was used for proportions like incidence and severity of PDPH; p<0.05 was taken as significant. Results: The incidence of PDPH was statistically not different (p = 0.361) in Group R 8% (4 patients) and in Group A 6% (3 patients). In both the groups, the severity of headache was mild to moderate with only mild headaches in the Group A (p = 0.549). Conclusions: Early ambulation following spinal anesthesia for caesarean section did not increase the incidence of PDPH in parturients.  

scholarly journals Post - Spinal Anesthesia Headache Treatment: a literature review

2021 ◽  
Author(s):  
Gabriel Aranha Sousa Maués ◽  
Rafaela Seixas Pinho ◽  
Aline Cristine Passos de Souza
Keyword(s):  
Literature Review ◽  
Spinal Anesthesia ◽  
Dural Puncture ◽  
Autologous Blood ◽  
Inclusion Criteria ◽  
Invasive Procedures ◽  
Exclusion Criteria ◽  
Study Objective ◽  
Post Dural Puncture Headache ◽  
Headache Treatment

Background: Post-spinal anesthesia headache is a common complication of this procedure due to the loss of cerebrospinal fluid through the puncture orifice. Resolution may be spontaneous or require interventions such as presented in this study. Objective: To address the most relevant and current aspects of post-spinal anesthesia headache treatment. Methods: Literature review based on Pubmed, Scielo and Google Scholar databases, having as inclusion criteria articles of great published in English, Portuguese and Spanish in the period 2016 to 2021 and exclusion criteria articles published outside that period. Results: Post-spinal anesthesia headache or post-dural puncture headache (DPC) is divided into disabling headache and non-disabling headache in order to guide its management. In non-disabling headache, analgesics, caffeine and hydration are used. In disabling headache, blood-patching can be performed from the injection of autologous blood in the epidural space in order to buffer the puncture hole. In addition to this technique, there is the blockade of the sphenuous- palatine ganglion, which is performed by applying 5% lidocaine with the aid of a swab, introduced perpendicularly to the nasopharynx, where the sphenuous ganglion is located – palatine ,inhibiting vasodilation from the blockage of parasympathetic transmission and thus decreasing the intensity of headache, considering the approachless invasive and with fewer complications, but that needs to be better studied for its application. Conclusion: The treatment of mistraining cppd from conservative to more invasive procedures and with a higher risk of complications. Due to the above, studies should be encouraged to expand the therapeutic arsenal of this disabling headache.

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

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