Efficacy of prophylactic epidural saline for reducing postdural puncture headache in patients undergoing caesarean section

Abstract

Aim: Post-Dural Puncture Headache (PDPH) is a common complication of spinal anesthesia during the postoperative period. The optimal means of prevention, management, and treatment of this disorder are uncertain. The objective of this current study was to investigate the effect of a 24 hours-continuous infusion of saline on the occurrence of PDPH in patients undergoing caesarean section and to provide a reference for the clinical prevention of PDPH.

Methods: This study included 126 patients aged between 18 and 45 years with an American Society of Anesthesiology physical status (ASA) score of 1-2, who underwent elective caesarean operation. Patients were randomized into control (n=63) and study groups (n=63). Spinal anesthesia was administered to both groups via a 27-gauche spinal needle. The study group was administered normal saline infusion for 24 hours with an easy-pump device through an epidural catheter. 

Results: Seven control-group patients developed PDPH within the first 72 hours postoperatively while it was not observed in any of the study-group patients. Visual analogue scale and numerical rating scales were used for pain measurement. Five patients described mild pain while two described moderate pain. Severe headache was not observed in any patients at any time.

Conclusion: This study demonstrated that the administration of epidural saline during an elective caesarean under spinal anesthesia significantly reduced the incidence of PDPH and was not associated with any side-effects.

Keywords

• Postdural Puncture Headache,Epidural saline,Spinal anesthesia,Cesarean section

Sezaryen uygulanan hastalarda postdural ponksiyon baş ağrısının azaltılmasında profilaktik epidural salinin etkinliği

Öz

Amaç: Postdural ponksiyon baş ağrısı (PDPH), ameliyat sonrası dönemde spinal anestezinin sık görülen bir komplikasyonudur. Bu bozukluğun önlenmesi, yönetimi ve tedavisi için en uygun yöntem belirsizdir. Bu çalışmanın amacı, 24 saat devam eden epidural salin infüzyonunun sezaryen geçiren hastalarda PDPH oluşumu üzerindeki etkisini araştırmak ve PDPH'nın önlenmesi için referans bilgi sağlamaktı.

Yöntemler: Çalışmaya Amerikan Anesteziyoloji Derneği fiziksel durumu (ASA) 1-2 olan, 18-45 yaş arası, elektif sezaryen ameliyatı yapılan 126 hasta dâhil edildi. Kontrol grubu (n=63) ve çalışma grubu (n=63) olarak belirlendi. Her iki gruba da 27 gauche spinal iğne ile spinal anestezi uygulandı. Çalışma grubuna epidural kateter yoluyla kolay pompa cihazı ile 24 saat boyunca normal salin infüzyonu yapıldı.

Bulgular: Kontrol grubunda 7 hastada ilk 72 saatte PDPH görülürken, çalışma grubunda PDPH görülmedi. Kontrol grubunda bulunan beş hasta, görsel analog skala ve sayısal derecelendirme skalasına göre PDPH’yi hafif ağrı ve iki hasta orta ağrı olarak tanımladı. Hastalarda şiddetli baş ağrısı görülmedi.

Sonuç: Bu çalışma, spinal anestezi altında elektif sezaryen sonrasında epidural salin uygulanmasının PDPH insidansını anlamlı derecede azalttığını ve herhangi bir yan etki ile ilişkili olmadığını göstermiştir.

Anahtar Kelimeler

• Postdural Ponksiyon Baş Ağrısı,Epidural salin,Spinal anestezi,Sezaryen

Kaynakça

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