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

Yıl 2019, Cilt: 2 Sayı: 1, 40 - 45, 30.04.2019

Ali Kartekin Mehmet Sargın Eyüp Aydoğan Sami Tutar Fatma Akın Sadık Özmen

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

Spinal anesthesia, post-dural puncture headache, cesarean section

Kaynakça

• 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.
• Alstadhaug KB, Odeh F, Baloch FK, et al. Post-lumbar puncture headache. Tidsskr Nor Laegeforen. 2012;132(7):818-21.
• 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.
• 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.
• 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.
• 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.
• 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.
• Ghaleb A. Postdural puncture headache. Anesthesiol Res Pract. 2010;2010. pii: 102967.
• 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.
• 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.
• 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
• 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.
• 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.
• 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.
• Bezov D, Lipton RB, Ashina S. Post-dural puncture headache : part1 diagnosis, epidomiology, etiology, and pathophsiology. Headache. 2010;50(7):1144-52.
• Gaiser R. Postdura puncture headache. Curr Opin Anaesthesiol.2006;19(3):249-53.
• Evans RW. Coplications of lumbar puncture. Neurol Clin. 1998;16(1):83-105.
• 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