Sezaryen Geçiren Hastalarda İntratekal Enjeksiyon Hızının Post-Dural Ponksiyon Baş Ağrısı Üzerine Etkisi: Prospektif, Randomize Çalışma

Abstract

Amaç: Bu çalışmada sezaryen geçiren hastalarda intratekal enjeksiyon hızının post-dural ponksiyon baş ağrısı (PDPBA) üzerine etkisinin değerlendirilmesi amaçlanmıştır.                                                     

Materyal ve Metot: Spinal anestezi ile sezaryen operasyonu planlanan 18-45 yaş arasında 140 hasta randomize olarak 2 gruba ayrılmıştır. Oturur pozisyonda L4-L5 seviyesinden, median girişle,  25G Quincke spinal iğne ile 10 mg hiperbarik 0.5% bupivakaine; Grup I’deki hastalara intratekal enjeksiyon olabildiğince hızlı bir şekilde uygulandı ve Grup II’deki hastalara intratekal enjeksiyon ile 40 sn içinde uygulandı. İntraoperatif dönemde hemodinamik verileri, efedrin kullanımı ve bulantı-kusma sıklığı kaydedildi. İşlem tarihinden 7 gün sonra hastalar telefon ile aranıp PDPBA yönünden sorgulandı. PDPBA’nın sorgulanmasında ICHD-III kriterleri kullanıldı. 

Bulgular: Gruplar arasında karşılaştırmada PDPBA insidansı (Grup I: %29.0 ve Grup II: %31.4) ve şiddeti açısından anlamlı bir fark bulunamamıştır (p>0.05). Hemodinamik veriler, efedrin kullanımı, bulantı kusma görülme sıklığı karşılaştırıldığında gruplar arasında anlamlı bir fark gözlenmemiştir (p>0.05).

Sonuç: Spinal anestezi ile sezaryen geçiren gebelerde, hiperbarik bupivakainin intratekal alana farklı hızlarda verilmesinin; PDPBA sıklığını ve şiddetini, hemodinamik parametreleri, efedrin gereksinimi ve bulantı kusma sıklığını etkilemediği kanaatindeyiz.

Keywords

• Spinal anestezi,post dural ponksiyon baş ağrısı,sezaryen

Effect of Intrathecal Injection Speed on Post-Dural Puncture Headache in Parturients Undergoing Cesarean Section: A Prospective, Randomized Study

Abstract

Aim: In this study, it was aimed to evaluate the effect of intrathecal injection rate on post- dural puncture headache (PDPH) in cesarean patients.

Material and Methods: 140 patients between 18-45 years of age who were scheduled for caesarean section with spinal anesthesia were randomly divided into two groups. From the L4-L5 level in the sitting position, 10 mg hyperbaric 0.5% bupivacaine with a 25 G Quincke spinal needle, median inlet; Intrathecal injection was performed as quickly as possible in the patients in Group I and administered to patients in Group II by intrathecal injection in 40 seconds. Hemodynamic data, ephedrine use and frequency of nausea and vomiting were recorded intraoperatively. 7 days after the procedure, the patients were called by phone and questioned for PDPH. The ICHD-III criteria were used to question the PDPH.

Results: There was no significant difference in the incidence of postdural headache (Group I: 29.0% and Group II: 31.4%) and severity (p> 0.05). There was no significant difference between the groups when haemodynamic data, ephedrine usage, nausea and vomiting frequency were compared (p> 0.05).

Conclusion: In the cases of cesarean section with spinal anesthesia, hyperbaric bupivacaine is given to the intrathecal area at different rates; We conclude that PDPH frequency and severity do not affect haemodynamic parameters, ephedrine requirement and frequency of nausea and vomiting.

Keywords

• Spinal anesthesia,post-dural puncture headache,cesarean section

References

1. Shaikh JM, Memon A, Memon MA, et al. Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25 g Quincke, 27 g Quincke and 27 g Whitacre spinal needles. J Ayub Med Coll Abbottabad. 2008;20(3):10-3.
2. Alstadhaug KB, Odeh F, Baloch FK, et al. Post-lumbar puncture headache. Tidsskr Nor Laegeforen. 2012;132(7):818-21.
3. Stendell L, Fomsgaard JS, Olsen KS. There is room for improvement in the prevention and treatment of headache after lumbar puncture. Dan Med J. 2012;59(7):A4483.
4. Imarengiaye CO, Edomwonyi NP. Evaluation of 25-gauge Quincke and 24-gauge Gertie Marx needles for spinal anaesthesia for caesarean section. East Afr Med J. 2002;79(7):379-81.
5. Tabedar S, Maharjan SK, Shrestha BR, et al. A comparison of 25 gauge Quincke spinal needle with 26 gauge Eldor spinal needle for the elective Caesarian sections: insertion characteristics and complications. Kathmandu Univ Med J. 2003;1(4):263-6.
6. Sakurai K, Matsukawa N, Okita K, et al. Lumbar puncture-related cerebrospinal fluid leakage on magnetic resonance myelography: is it a clinically significant finding? BMC Anesthesiol. 2013;13(1):35.
7. Dodge HS, Ekhator NN, Jefferson-Wilson L, et al. Cigarette smokers have reduced risk for post-dural puncture headache. Pain Physician. 2013;16(1):25-30.
8. Ghaleb A. Postdural puncture headache. Anesthesiol Res Pract. 2010;2010. pii: 102967.

9. Prakash S, Bhartiya V, Pramanik V, et al. The effect of injection speed on the spinal block characteristics of hyperbaric bupivacaine 0.5% in the elderly. J Anesth. 2010;24(6):877-81.
10. Van Oosterhout WP, Van der Plas AA, Van Zwet EW, et al. Postdural puncture headache in migraineurs and nonheadache subjects: a prospective study. Neurology. 201;80(10):941-8.
11. A.Casati, G. Fanalli, G. Cappelleri, et al. Does speed of intrathecal injektion affect the distribution of 0.5% hyperbaric bupivacaine? British Journal of Anaesthesia. 1998;81:355-357
12. Bouchnak M, Belhadj N, Chaaoua T, et al. Spinal anaesthesia for caesarean section: dose injection speed have an affect on the incidence of hypatension? Ann Anesth Reanim. 2006;25(1):17-9.
13. Sing SI, Morley-Forster PK, Shamsak M, et al. Influance of injection rate of hyperbaric bupivacaine on spinal block in parturients: a randomized trial. Can J A naesth. 2007;54(4):290-5.
14. Elisabeth F, Van Gessel, Jacqueline P, et al. Influence of injection speed on the subarachnoid distribution of isobaric bupivacaine 0.5%. Anesth Analg. 1993;77:483-7.
15. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache : part1 diagnosis, epidomiology, etiology, and pathophsiology. Headache. 2010;50(7):1144-52.
16. Gaiser R. Postdura puncture headache. Curr Opin Anaesthesiol.2006;19(3):249-53.
17. Evans RW. Coplications of lumbar puncture. Neurol Clin. 1998;16(1):83-105.
18. Evans RW, Armon C, Frohman EM, et al. Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assesment subcommttie of the american academy of neurology. Neurology. 2000;55(7):909-14