A Comparison of the Effects of Spinal Anaesthesia between Sitting and Lateral Positions in Patients Undergoing Hysterectomy Surgery

Aim: The main purpose of this present study is to determine the effects of sitting (S) and lateral (L) position during spinal anaesthesia on patient satisfaction, Post dural puncture headache (PDPH), Post-Operative Nausea and Vomiting (PONV). Study Design: Prospective comparative study Place and Duration of Study: Charusat Healthcare and Research foundation (CHRF), Changa, Gujarat, between September 2021 to November 2021. Methodology: A total of 50 female volunteers who were above the age of 18 years, had an American Society of Anaesthesiologist (ASA) status of I & II and those who have undergone hysterectomy surgery are included in this study. The patients were categorized into two groups, group S (n=25) and group L (n=25). Patients were asked about PONV 4 hours after surgery and the possibility of PDPH on post-operative days 1 and 2. The study was analysed by using descriptive statistics, chi-square and Kruskal-Wallis test. Results: When comparing the incidence of PDPH on post-operative day 1 and day 2, there is a statistically significant difference between the Sitting (group S) and Lateral decubitus (group L) groups (P-value= 0.14 and.001). On the other hand, there is no statistical significant difference found for PONV when compared between both the groups (P- value= .776). Conclusion: Spinal anaesthesia with lateral decubitus position has better outcomes than sitting position for the incidence of Post dural puncture headache. However, there is no difference in both groups for PONV.

Frequency of Post Dural Puncture Headache with Quincke 25g and Quincke 27g Spinal Needle after Spinal Anaesthesia

Objective: To compare the frequency of post dural puncture headache with Quincke 25G and Quincke 27G of spinal needles for spinal anesthesia. Design of the Study: It’s a Randomized control trial. Study Settings: This study was carried out Department of anesthesiology and Intensive Care Unit, Shaikh Zayed Hospital Lahore from 29-08-2020 to 01-03-2021. Material and Methods: In this prospective study 100 patients were enrolled who were decided to undergo spinal anesthesia. Two groups were made by randomization. In patients of group I, anesthesia was administered by using 25G quincke needle while 27G quincke needle was used for patients in group II. Evaluation of patients was with regard to development of postoperative PDPH within 3-days. Groups were compared by using Chi-square test and a P-value<0.05 was taken statistically significant. Results of the Study: PDHD was seen in 14 (28%) patients in group I and in 4 (8%) patients in group II. Statistically, the difference between the two groups was significant (p<0.05).. Conclusion: Due to less frequency of PDPH with 27G needle, it should be given preference for applying spinal anesthesia over 25G needle. Keywords: Spinal anesthesia, post dural puncture headache; quincle needle.

Low-dose Propofol for the Treatment of Severe Postpartum Post-dural Puncture Headache: A Case Report

In this report, we presented our experience in treating severe postpartum post-dural puncture headache with low-dose propofol. Short-term use of low-dose propofol provided rapid and complete relief of the headache without recurrence.

Aminophylline for Prevention and/or Treatment of Post-Dural Puncture Headache: A Systematic Review and Meta-Analysis Study Protocol

Objectives: Post-dural Puncture Headache (PDPH) is prevalent among individuals undergoing lumbar punctures. The non-invasive effect of some drugs, such as aminophylline on PDPH has been investigated in several clinical studies. As there is no comprehensive systematic review and meta-analysis about the preventive and therapeutic effects of aminophylline on PDPH in the literature, the clinical effectiveness of this drug on the prevention and/or treatment of PDPH will be assessed in this study. Methods: PubMed/MEDLINE, Embase, WoS (Clarivate Analytics), the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete, Scopus, and Google Scholar as electronic databases will be precisely searched for clinical studies that assessed the effect of aminophylline on PDPH. Studies between 01-01-1980 and 30-06-2020 will be evaluated in this study, and there will not be any language restrictions. Contradictions between the reviewers within any phase of the study (screening, selecting, quality assessment, and data extraction) will be resolved by consensus; in case of unsolved disagreements, a third reviewer will eventually decide. The combination method will be applied according to the methodological resemblance in the selected articles using the Random Effect Model or the Fixed Effect Model. Also, for the included articles, forest plots will be drawn. For assessing statistical heterogeneity, the I2 statistic and the Q-statistic test will be applied. In addition, funnel plots will be used for assessing non-significant study effects and potential reporting bias. Furthermore, Egger’s and Begg’s tests will be done, and publication bias will be indicated by significant findings (P < 0.05). Conclusions: It is expected that the results of this study will be of benefit to researchers and clinicians for managing PDPH, and will be reported in conferences and publications.

A comparative study between the effect of Aminophylline, Neostigmine and Gabapentin on prevention of post dural puncture headache after cesarean section

Objectives Post dural puncture headache (PDPH), since it is first described by August Bier in 1898, remains a common complication in spinal anesthesia (SA). Many pharmacological agents are suggested for PDPH management as acetaminophen, caffeine, non-steroidal antiinflammatory drugs, corticosteroids, and sumatriptan. Aim The aim of this study is to compare between the prophylactic effect of each of; aminophylline, gabapentin, and neostigmine added to atropine on the occurrence of PDPH after caesarean section (CS) under SA. Subjects and Methods This prospective randomized controlled clinical study was carried out 75 pregnant female patients 20-40 y, 60-100 kg. ASA physical status II undergoing elective CS. Patients were randomly divided into 3 groups (25 patients in each); group A: received 250 mg aminophylline IV immediately after delivery of the infant, group B: received IV neostigmine 20 µg/kg added to atropine 10 µg/kg immediately after delivery of the infant and group C: received 3 capsules gabapentin 300 mg; the 1st before SA by 2 h with sip of water, the 2nd after CS by 6 h and the 3rd after 14 h from CS. Results The incidence of PDPH was lower in group A (8% vs 40% in group B and 24% in group C. The onset of PDPH was significantly delayed in group C than group A and in group C than B, but insignificant between group A and B. The duration of PDPH and total dose of analgesic requirement was significantly lower in group A than group B and C and in group B than C. Heart rate (HR) showed significant increase in group A (post aminophylline than pre) only. HR in the other groups and mean arterial blood pressure showed insignificant difference among the three groups (between pre and post administration of drugs). As regards VAS, there was no significant difference in the three groups at 3 h. There was significant difference among the three groups at 6, 12, 24, 36, 48 and 72 h. (between group A & B from 24h up to 72h, between group A & C from 6 up to 72h and between group B & C at 6 h only (delayed onset with neostigmine)). Side effects were minimal and tolerable. Conclusion Aminophylline reduced the incidence and duration of PDPH after CS under SA more than gabapentin and neostigmine with less analgesic requirement and minimal side effects. Also, neostigmine was superior than gabapentin in delaying the onset and decreasing the duration of PDPH.

Post-dural Puncture Headache in Cesarean Section; Frequency and Risk Factors: A Report From the North of Iran

Background: Spinal Anesthesia (SA) as a safe, reliable, and cost-effective method is widely used for Cesarean Section (CS). However, it is sometimes complicated by Post-Dural Puncture Headache (PDPH). Objectives: We investigated the frequency of PDPH in CS under SA and related risk factors in an academic referral hospital in the north of Iran. Materials & Methods: This descriptive cross-sectional prospective study was conducted at Alzahra hospital as an academic referral center affiliated with the Guilan University of Medical Sciences on 147 eligible cases During from May 2019 to October 2019. Then questionnaires containing questions about patients’ demographic data and some PDPH-related factors were filled out via face-to-face interviews. The collected data were analyzed by SPSS v. 21 using Chi-squared and and Fisher’s exact test. Results: The incidence of PDPH was 6.1%. Early ambulation, the number of attempts, and having a history of headache were significantly associated with a higher incidence of PDPH (P=0.001), while body mass index (P=0.106), age (P=0.093), and residents’ experience (P=0.384) had no significant association. None of our cases experienced a severe or persistent headache. Conclusion: The main predisposing factors for PDPH were found to be the history of HA, early ambulation, and the number of dura punctures. Women at risk for PDPH should be objectively screened before CS under SA.