25G, 27G ve 29G Quincke İğneler ile Spinal Anestezi Uygulanan Sezaryen Hastalarında Postoperatif Baş Ağrısı Sıklığı ve Şiddetinin Karşılaştırılması.

Yıl 2018, , 32 - 36, 01.08.2018

Mustafa Kemal Yıldırım , Haci Ömer Osmanlıoğlu Berit Gökçe Ceylan Füsun Eroğlu

https://doi.org/10.22312/sdusbed.440482

Öz

ÖZET

25G,
27G ve 29G Quincke İğneler ile Spinal Anestezi Uygulanan Sezaryen Hastalarında
Postoperatif Baş Ağrısı Sıklığı ve Şiddetinin Karşılaştırılması.

              Amaç: Bu
çalışmanın amacı 25G, 27G ve 29G
quincke iğneler ile spinal anestezi uygulan sezaryen hastalarında ameliyat
sonrası spinal anesteziye bağlı gelişen baş ağrısı sıklığını ve şiddetini karşılaştırmak.

             Gereç
ve Yöntem: SDÜ Tıp
Fakültesi Klinik Araştırmalar Yerel Etik Kurulunun onayı alındıktan sonra, ASA
I-II, 18 yaş üzeri elektif sezaryen cerrahisi planlanan 60 hasta çalışmaya
alındı. Hastalar randomize olarak 3 gruba ayrıldı. Grup I hastalara (n=20) 25G,
Grup II hastalara (n=20) 27G, Grup III hastalara (n=20) 29G (kılavuzlu) quincke
keskin uç iğneler kullanılarak spinal anestezi uygulandı. Spinal anestezi
başarısız veya yetersiz olan hastalarda genel anesteziye geçildi ve hastalar
çalışma dışı bırakıldı. Hastalarda baş ağrısı gelişip gelişmediği, ağrının
süresi ve şiddeti 2. haftaya kadar gerekirse telefonla hastalara dönüş
yapılarak sorgulandı ve kayıt altına alındı. Baş ağrısı şiddeti Lybecker
sınıflamasına göre derecelendirildi.

              Bulgular: Toplamda 60 hastanın 9' unda (15,0 %) postdural
ponksiyon santral baş ağrısı (PDPBA) oluştu. Grupların kendi içinde dağılımı;
Grup I' de 20 hastanın 5' inde (25.0 %), Grup II' de 20 hastanın 3' ünde (15.0%),
Grup III' de 20 hastanın 1' inde (5.0%) PDPBA oluştu. Grup I' de 2 hastada
şiddetli baş ağrısı olurken Grup II ve Grup III' de şiddetli baş ağrısı
olmamıştır. Gruplar arasında PDPBA insidansı açısından istatiksel olarak anlamlı
bir fark bulunmadı.    

            Sonuç:
Farklı iğne
boyutları arasında istatistik olarak fark bulunmasa da PDPBA riskini en azından
önlemek için eğer elde edilebiliyor ise klinik pratikte 29 G kılavuzlu keskin
uçlu iğne tercih edilebilir.

Anahtar Kelimeler

Sezaryen, Spinal anestezi, Baş ağrısı

The Comparison of Postoperative Headache Frequency and Severity on Sectio Patients that Spinal Anaesthesia Performed with 25G, 27G and 29G Quincke Needles

Öz

ABSTRACT

The
Comparison of Postoperative Headache Frequency and Severity on Sectio Patients
that Spinal Anaesthesia Performed with 25G, 27G and 29G Quincke Needles

             Aim: The
aim of this study is to compare the frequency and severity of post spinal headache
between the sectio patients that was spinal anaesthesia performed with 25G, 27G
and 29G quincke needles.

         Materials and Methods:
Following the approval of Clinical researches local Ethics Committee of
Suleyman Demirel University 60 ASA I-II clinical status patients above 18 years
that sectio operation was planned included in the study. Patients were
ramdomised to three groups. The spinal anaesthesai was performed with 25G
guided quincke sharp-tipped needle to Group I (n=20), with 27G needle in Group
II (n=20) and with 29G needle in Group III (n=25). General anesthesia was performed
in unsuccessful spinal anaesthesia patients and they were excluded from the study.
The headache, the time and the severity till the second week of the operation and
was asked and reported .The severity was degreed according to Lybecker classification.

          Results:
Postdural central headache was reported on 9 of total 60 patients (15,0 %). The
distribution was as : 5 patients in Group I (25.0 %), 3 patients in Group II (15.0
%), and 1 patient in Group III (5.0%). Severe headache was occurred in 2
patients in Group I and was not occurred in any patients in Group II and III. There
was no significany difference istatistically between groups by the means of
postdural puncture headache.

       Conclusion:
At least for preventing the risk,
although there is no statistically difference between different needle sizes;
we think that 29G guided needle may be preferred in the clinical practice if
available.

Anahtar Kelimeler

Sectio, Spinal anaesthesia, Headache

Kaynakça

• 1. Keleş E, Yazgan H, Gebeşçe A, Pakır E. The Type of Anesthesia Used during Cesarean Section Is Related to the Transient Tachypnea of the Newborn. ISRN Pediatr. 2013;24;2013:264340.
• 2. Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA. Postspinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med. 2013;4(1):595-602.
• 3. 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;4:6(4):e35486
• 4. Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches. Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2000; 55:909-914.
• 5. Hoefnagel A, Yu A, Kaminski A. Anesthetic Complications in Pregnancy. Crit Care Clin. 2016;32(1):1-28. 6. Murtaza G, Khan A, Abbas N, Tariq S.Frequency of postdural puncture headache followıng spınal anaesthesıa for caesarean sectıon: a comparıson between 25-g and 27-g pencıl poınt spınal needles. IntI. Chern. Pharrn. Med. J. 2005;2(1);163-l74
• 6. Murtaza G, Khan A, Abbas N, Tariq S.Frequency of postdural puncture headache followıng spınal anaesthesıa for caesarean sectıon: a comparıson between 25-g and 27-g pencıl poınt spınal needles. IntI. Chern. Pharrn. Med. J. 2005;2(1);163-l74
• 7. Syed S, Qayoom N, Naaz S, Mushtaq K, Mir AH, Bijli AH et al. Comparison of post-dural puncture headache- incidence and severity in obstetric patients after spinal anesthesia for caesarean section with 25G and 27G quincke needle. Int J Res Med Sci. 2017;5(2):596-600
• 8. Srivastava V, Jindal P, Sharma JP. Study of post dural puncture headache with 27G Quincke&Whitacre needles in obstetrics/nonobstetrics patients.Middle East J Anaesthesiol. 2010;20(5):709-17.
• 9. Purtuloğlu T , Özkan S, Teksöz E, Dere K, Şen H, Yen T et al.[ Comparison of the maternal and fetal effects of general and spinal anesthesia in elective cesarean section]. Gülhane Tıp Dergisi 2008;50: 91-97
• 10. Mancuso A, De Vivo A, Giacobbe A, Priola V, Maggio Savasta L,Guzzo M et al. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. J Matern Fetal Neonatal Med. 2010;23:1114-8.
• 11. Tonni G, Ferrari B, De Felice C, Ventura A. Fetal acid-base and neonatal status after general and neuraxial anesthesia for elective cesarean section. Int J Gynaecol Obstet. 2007;97:143-6.
• 12. Kwak KH.Postdural puncture headache.Korean J Anesthesiol. 2017;70(2):136-143
• 13. Gaiser RR. Postdural Puncture Headache: An Evidence-Based Approach. Anesthesiol Clin. 2017;35(1):157-167.
• 14. Katı İ., Demirel CB, Abbasov ÜH., Silay E., Coşkuner, Tokmak Y. [The Effects Of Needle Type On Complications Of Spinal Anesthesia]. Van Tıp Dergisi, 2002;9:2
• 15. Shah A, Bhatia PK, Tulsiani KL. Postdural puncture headache in caesarean section: A comparative study using 25G Quincke, 27G Quincke and 27G Whitacre Needles. Indian J Anesth. 2002;46(5):373-77.
• 16. Ayub F, AhmadA , Aslam K , Saleem I. Frequency of headache with 25G or 27G quincke needles after spinal anesthesia in patients under going elective cesarean section. Anaesthesıa, Pain&Intensive Care; 2017;21(2) 17. Neves J, Monteiro G, Almeida J, Brun A, Anna R, Duarte E. Spinal Anesthesia with 27G and 29G Quincke and 27G Whitacre Needles. Technical Difficulties, Failures and Headache. Rev Bras Anestesiol 2001; 51: 3: 196 - 201
• 17. Neves J, Monteiro G, Almeida J, Brun A, Anna R, Duarte E. Spinal Anesthesia with 27G and 29G Quincke and 27G Whitacre Needles. Technical Difficulties, Failures and Headache. Rev Bras Anestesiol 2001; 51: 3: 196 - 201