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Is There An Effect On The Development Of Postdural Puncture Headache Of Dural Punction Made With The Spinal Needle In Three Different Orientations During Spinal Anaesthesia Applied To Pregnant Patients?

Authors Bıçak M, Salık F, Akelma H

Received 18 August 2019

Accepted for publication 30 September 2019

Published 22 November 2019 Volume 2019:12 Pages 3167—3174

DOI https://doi.org/10.2147/JPR.S227717

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Michael A Überall


Mustafa Bıçak, Fikret Salık, Hakan Akelma

Health Sciences University, Gazi Yaşargil Training and Research Hospital, Department of Anesthesiology and Reanimation Clinic, Diyarbakir, Turkey

Correspondence: Hakan Akelma
Gazi Yaşargil Training and Research Hospital, Department of Anesthesiology and Reanimation Clinic, Diyarbakır 21010, Turkey
Tel +904122580071
Fax +904122580072
Email hakanakelma@hotmail.com

Background and objectives: Postdural punction headache (PDPH) is a well-known and common complication of spinal anesthesia. The relationship between spinal needle size, configuration and perforation characteristics of the spinal needle and non-essential leak continues to be controversial.
Methods: This prospective-randomized study included 300 patients aged 18–45 years who underwent cesarean section under spinal anesthesia. Spinal anesthesia was performed using a 26G Quincke spinal needle in the L3-4, or L4-5 range in the sitting position. Spinal anesthesia was performed with spinal needle sharp tip opening in the Group 1 patients, right or left laterally in Group 2 and caudal in Group 3, transducing the dural fibers transversely to the subarachnoid area, and directing the free opening of the needle to the spine. The patients were visited in the clinic where they were hospitalized at the 24th and 48th hours postoperatively, and phoned on the 3rd and 5th days after discharge, being questioned for PDPH.
Results: It was observed that 64% of patients with PDPH developed within the first 24 hrs, 24% between 24 and 48 hrs and 48–72 hrs in 12%. The incidence of PDPH was 14% in Group 1, 8% in Group 2 and 3% in Group 3. This difference between the groups was statistically significant (p: 0.019). The incidence of PDPH was lower in Group 3 than in Group 1 and Group 2.
Conclusion: We suggest that when spinal anesthesia is applied in the obstetric patient group if needle opening faces caudal this method will reduce the frequency of PDPH.

Keywords: spinal anaesthesia, pregnant patients, orientations needle, postdural punction headache

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