Frequency Of Postdural Puncture Headache Research Articles

Effects of Dexamethasone on Post-dural Puncture Headache in Patients Undergoing Orthopedic Surgery

Background: The effect of Dexamethasone on Post-Dural Puncture Headache (PDPH) after spinal anesthesia has not been well elucidated. The aim of the current study was to evaluate the effect of prophylactic intravenous dexamethasone on the incidence and severity of PDPH in patients undergoing orthopedic surgery. Methods: This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing orthopedic surgery. The subjects were randomly divided into a placebo (n=140) and a dexamethasone (n=140) group. During the surgery, the control group participants were injected 2cc of distilled water, and the dexamethasone group participants were injected 2cc (8mg) of dexamethasone as an infusion in the veins. The incidences of PDPH on the first, third and seventh postoperative days were studied. Data were analyzed using SPSS version 22. Results: A total of 280 patients with a mean age of 32.7 ± 11.0 years were studied. The incidence of PDPH on the first day of post-operative period was lower in the dexamethasone group than the control group (21 vs. 34, P<0.05). This difference was disappeared on days 3 and 7. Nausea or vomiting occurred less in the dexamethasone group (9 vs. 26, P<0.05). However, no statistically significant association was found between study groups and the incidence of back pain (P>0.05). Conclusion: Although the frequency of PDPH was less in patients receiving dexamethasone, the incidence increased days after the operation and reached the level of the placebo group. We do not recommend prophylactic intravenous dexamethasone for the prevention of PDPH.

Incidence and risk factors of postdural puncture headache: prospective cohort study design

BackgroundPostdural puncture headache is one of the complications following spinal anesthesia and accidental dural puncture. Several modifiable risk factors contribute to the development of headache after lumbar puncture, which includes needle size, needle design, direction of the bevel, and number of lumbar puncture attempts. This study aimed to assess the incidence and risk of postdural puncture headache.MethodsThis prospective cohort study design was conducted using a consecutive sampling method. Regular supervision and follow-up were performed. Data were entered into Epi info version 7 software and transported to SPSS version 20 for analysis. The odds ratio and 95% confidence interval were computed. The findings of the study were reported using tables, figures, and narrations. Variables that were found to be candidates (p value < 0.25) on binary logistic regression entered into a multiple logistic regression analysis to identify independent predictors of postdural puncture headache.ResultsOne hundred fifty eligible study participants were included in our study, of which 28.7% had developed postdural puncture headache. This study found that needle size, number of cerebrospinal fluid drops, and multiple attempts were significant independent predictors of postdural puncture headache (p < 0.05). In addition, twenty-five needles were identified as the strongest preoperative independent predictor of postdural puncture headache (AOR = 4.150, CI = 1.433–12.021)ConclusionsA recent study revealed that a small spinal needle was much better than a large cutting spinal needle regarding the frequency of postdural puncture headache. In addition, frequent attempts during lumbar puncture and increased cerebrospinal fluid leakage were associated with the events. In view of this, we recommend the use of a small spinal needle to avoid more leakage of cerebrospinal fluid and multiple attempts at spinal anesthesia and lumbar puncture.

Incidence of Postdural Puncture Headache after Caesarean Section Comparison Between 25G and 27G Quincke Variety of Spinal Needle

Background: Post dural puncture headache is related to the size as well as type of the spinal needle used90. It is progressively reduced with the use of thinner Quincke type spinal needles.Objective: This was a Quasi-experimental study to compare the incidence of post dural puncture headache after caesarian section with spinal anaesthesia by two typys of needles named 25G and 27G Quincke varities.Methods: This study was conducted in the Department of Anaesthesiology of Shaheed Shurawardy Medical College Hospital, Dhaka. A total number of 60 adult patients with ASA physical status I &amp; II scheduled for elective surgical caesarian section under spinal anaesthesia were enrolled in this study. Patients were randomly allocated equally, 30 in each group into two groups I and II. Patients of Group I, II received 25G and 27G quincke variety of spinal needle respectively. The randomization was double blind except for the anaesthetist performing spinal block. Patient, surgeon and the assessor in the ward was aware of the study. Spinal anaesthesia was performed with 2.0-2.5 ml 0.5% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I),and 27G Quincke spinal needle (Group II) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Incidence and severity of postdural puncture headache (PDPH) was recorded.Result: Seven (7) out of 60 patients developed PDPH giving an overall frequency of 11.6% (Table-2). Frequency of PDPH was 16.7% (5/30) in Group I, 6.7% (2/30) in Group II. In Group I, PDPH was mild in 3 patients (60%), moderate in 1 patient (20%) and severe in 1 patient (20%). In Group II, it was mild in 2 (100%), moderate in 0 and severe in 0 patient. Moderate and Severe PDPH was not observed with 27G Quincke spinal needle (Group II). None of the 60 patients with PDPH required an epidural blood patch. Symptoms were relieved by conventional means in all patients.Conclusion: In current practice epidural blood patch has the highest cure rate for management of PDPH and is usually very well tolerated by majority of patients. Overall, we concluded that when performing spinal anaesthesia for Caesarean section, 27G Quincke spinal needle has definite advantage over 25G Quincke spinal needles as far as frequency and severity of PDPH is concerned. Therefore we recommend routine use of the 27G Quincke spinal needle when performing spinal anaesthesia for Caesarean section.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 762-769

Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: A meta-analysis.

Background:Postdural puncture headache (PDPH), mainly resulting from the loss of cerebral spinal fluid (CSF), is a well-known iatrogenic complication of spinal anesthesia and diagnostic lumbar puncture. Spinal needles have been modified to minimize complications. Modifiable risk factors of PDPH mainly included needle size and needle shape. However, whether the incidence of PDPH is significantly different between cutting-point and pencil-point needles was controversial. Then we did a meta-analysis to assess the incidence of PDPH of cutting spinal needle and pencil-point spinal needle.Methods:We included all randomly designed trials, assessing the clinical outcomes in patients given elective spinal anesthesia or diagnostic lumbar puncture with either cutting or pencil-point spinal needle as eligible studies. All selected studies and the risk of bias of them were assessed by 2 investigators. Clinical outcomes including success rates, frequency of PDPH, reported severe PDPH, and the use of epidural blood patch (EBP) were recorded as primary results. Results were evaluated using risk ratio (RR) with 95% confidence interval (CI) for dichotomous variables. Rev Man software (version 5.3) was used to analyze all appropriate data.Results:Twenty-five randomized controlled trials (RCTs) were included in our study. The analysis result revealed that pencil-point spinal needle would result in lower rate of PDPH (RR 2.50; 95% CI [1.96, 3.19]; P < 0.00001) and severe PDPH (RR 3.27; 95% CI [2.15, 4.96]; P < 0.00001). Furthermore, EBP was less used in pencil-point spine needle group (RR 3.69; 95% CI [1.96, 6.95]; P < 0.0001).Conclusions:Current evidences suggest that pencil-point spinal needle was significantly superior compared with cutting spinal needle regarding the frequency of PDPH, PDPH severity, and the use of EBP. In view of this, we recommend the use of pencil-point spinal needle in spinal anesthesia and lumbar puncture.

The Rate and Severity of Headache after Caesarean Section under Spinal Anaesthesia are decreased by Hypertonic Solutions: A Randomized Placebo-Controlled Clinical Trial

Aim: To determine the frequency and severity of post-dural puncture headache (PDPH) in women undergoing spinal anaesthesia for caesarean section who received an infusion of Voluven or Ringer before the procedure. Methods: We enrolled 240 full term women scheduled for elective caesarean section in this study. Participants were randomly allocated equally to Ringer (A) and Voluven (B) groups. After arrival in the operating room 500 ml of ringer solution was infused within 10-15 min before spinal block in the Ringer group, but in the Voluven group 500 ml of 6% Hydroxyethyl starch solution was infused to the patients. The frequency and severity of headache were compared between two groups. Results: The frequency of PDPH was higher in patients in Ringer group compared to Voluven group at first day (P=0.01), but there were no significant differences between two groups in second (p=0.23) and third days (p=0.30). The severity of headache in Ringer group was significantly more than patients in Voluven group in every three days significantly. Hypotension occurred in 95 patients in Ringer Group (79.17%) and in 76 patients in Voluven Group (%63.33) (P=0.007). The frequency of nausea and vomiting was seen in 27 patients in Ringer group (22.5%) vs. in 18 patients in Voluven group (15%) (p=0.10). Conclusion: Hydration with hypertonic solutions (Voluven) before caesarean section under spinal anaesthesia can decrease the rate and severity of PDPH compared with hydration with Ringer solution.

Efficacy of different size Quincke spinal needles in reduction of incidence of Post-Dural Puncture Headache (PDPH) in Caesarean Section (CS). Randomized controlled study

BackgroundRegional analgesia first introduced in clinical practice by the German surgeon Karl August Bier (1898). Spinal, epidural or combined spinal and epidural anaesthesia became the first line of choice in obstetric surgery. PDPH was found to be more frequent after Caesarean Section in young parturients. Also PDPH is related to CSF leakage from the subarachnoid space.ObjectivesThis prospective, double blinded, randomized study compares the frequency of PDPH following spinal anaesthesia for CS and technique difficulty with 22G, 25G and 29G Quincke needles.MethodsOne hundred and eighty ASA I and II full term pregnant females aged 20–40 years, scheduled to receive spinal anaesthesia for elective CS, were randomly divided into three equal groups (n = 60 each). Each group received spinal anaesthesia with 22G (GI), 25G (GII) and 29G (GIII) Quincke needle. Difficulty in localizing the subarachnoid space and time taken to administer spinal anaesthesia were noted. Post-operatively; incidence, onset, site, duration and severity of headache were also studied.ResultsPDPH occurred in 19 patients (31.7%) in GI, 7 patients (11.7%) in GII and 0 patients in GIII. However, the time taken to get CSF from onset of needle insertion was significantly different between the three groups; {13.6(5.2), 28.7(11.1) and 113.5(27.4) sec. mean(SD) in GI, GII and GIII} respectively. The duration of local anaesthetic injection through the spinal needles was significantly different between the three groups; {9.3(0.6), 15.3(1.2) and 37.4(1.7) sec. mean(SD); GI, GII and GIII} respectively. Also time to reach T4 block was significantly longer in GIII when compared with other groups; {5.7(0.8), 5.7(1.1) and 8.0(0.7) min. mean(SD); GI, GII and GIII} respectively. P < 0.05. Conclusion: Spinal anaesthesia with a 29G needle reduced the incidence of PDPH in elective CS to 0%. However, it is significantly more time consuming to give spinal anaesthesia with 29G needle than with the other needles.

Dexamethasone Increases the Frequency of Post-Dural Puncture Headache (PDPH): An Evidence Based Reality.

Dexamethasone Increases the Frequency of Post-Dural Puncture Headache (PDPH): An Evidence Based Reality.

Post Dural Puncture Headache After Spinal Anaesthesia and Chance Of Spinal Failure: A Comparative Study Using 23 G Quincke, 25G Quincke, And 25 G Whitacre Needle

Objective: To compare the frequency and severity of postdural puncture headache (PDPH) and technical difficulties in patient of age 18 -60 year planed for lower abdominal surgery. Method: 75 patient of age group 18-60 years with ASA I and ASA II, scheduled for abdominal surgery in spinal anaesthesia were taken and were divided into three groups of 25 patient each, accordingly to the size and shape of the needle, 23 G Quincke (Group I) , 25 G Quincke (Group II) and 25 G Whitacre (Group III) . Parameters observed are frequency of PDPH, severity of PDPH and technical problem in term of number of attempt and failure rate. Result: The incidence of PDPH was 24% in Group I, 12% in Group II, and 4% in Group III. (p –value >0.05), Group III patient were having very mild headache. Subarachnoid space was located successfully in first attempt in 92% cases in Group I, 52% cases in Group II , 40% cases in Group III . Conclusion: 25 G Whitacre needle seems to be suitable choice in patient because of its ease of handling with low incidence PDPH.

Lower incidence of postdural puncture headache using whitacre spinal needles after spinal anesthesia: A meta-analysis.

The aim of this meta-analysis was to evaluate the postdural puncture headache after spinal anesthesia with Whitacre spinal needles compared with Quincke spine needles. We searched several databases, including PubMed, Embase, ISI Web of Knowledge, and Cochrane Central Register of Controlled Trials until October 10th, 2014, for randomized controlled trials that compared spinal anesthesia with Whitacre spinal needles or Quincke spine needles for postdural puncture headache. Two reviewers independently screened the literature, assessed the risk for bias and extracted data. We used RevMan 5.3 software to perform the meta-analysis. Studies were included for the main end points if they addressed the following: frequency of postdural puncture headache, severity of postdural puncture headache as assessed by limitation of activities, and frequency of epidural blood patch. Nine randomized controlled trials were included for meta-analysis. The meta-analysis showed that spinal anesthesia with Whitacre spinal needles achieved lower incidence of postdural puncture headache(RR 0.34; 95% CI [0.22, 0.52]; P < .00001); in addition, the severity of postdural puncture headache was lower in the Whitacre spinal needle group (RR 0.32; 95% CI [0.16, 0.66]; P = .002). Furthermore, the frequency of an epidural blood patch in the Whitacre spinal needle group was lower compared with that in the Quincke spine needle group (RR 0.15; 95% CI [0.04, 0.51]; P = .002). We suggest the Whitacre spinal needles as a superior choice for spinal anesthesia compared with Quincke spine needles.

PDPH BY USING SAME GAUGE OF NEEDLES

There is increase incidence of Lower Segment Caesarian section (LSCS) being performed under sub-arachnoid block (SAB)because it is relatively safe. One of the complications of SAB is Post Dural Puncture Headache (PDPH) which is very distressing to the patient.Objective: To observe the incidence of PDPH by using two different types of spinal needle of 25 gauge in females undergoing LSCS underSAB. Currently, in our setup 25G cutting (quincke) spinal needle is routinely used. Study design: Randomized controlled trial. Setting:Department of Anesthesia, Officers Family Hospital, Rawalpindi Cantt. Duration of study: 6 months from 15 February 2011 to 15 July 2011.Material and Method: 100 pregnant patients undergoing elective CD under spinal anaesthesia were randomized into two groups A &amp; B. GroupA received SAB with 25G Quincke needle; Group B- received SAB with 25G pencil-point needle. Follow up was done upto 72 hours after thesurgery. Data obtained through study was analysed through computer software SPSS version 12. Quantitative variables like age, weight andheight are presented as mean and standard deviation. The frequency of PDPH was qualitatively analysed in percentage. The frequency ofPDPH was compared between two groups with the application of Chi-square as test of significance at P- value&lt;0.05. Results: It was found thatthe incidence of PDPH with Quincke (cutting tip) needle was significantly higher (7.%) as compared to pencil point needle (0%). Conclusion:pencil-point spinal needle is associated with lesser incidence of PDPH and should be preferred to Quincke needle to achieve SAB in patientsundergoing LSCS.

Effect of dexamethasone on the frequency of postdural puncture headache after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

In this study, we evaluated the effect of dexamethasone used as a prophylaxis for nausea and vomiting on the incidence of postdural puncture headache (PDPH) in pregnant women receiving spinal anesthesia for cesarean section. In a prospective, randomized, double-blind, placebo-controlled study, 372 women under spinal anesthesia received 8 mg of dexamethasone or placebo intravenously just after the umbilical cord was clamped. The rate of PDPH and correlated risk factors were evaluated. The prevalence of nausea and vomiting in the dexamethasone and placebo groups was 54.4 and 51.7%, respectively. There was no statistically meaningful difference between the results (P value = 0.673). The overall incidence rate of PDPH was 10.8%, with 28 cases from the dexamethasone group compared with 11 subjects from the placebo group (P value = 0.006). This effect was most prominent on the first day (P value = 0.046) and disappeared on the second day after spinal anesthesia (P value = 0.678). Prophylactic treatment with 8 mg of dexamethasone not only increases the severity and incidence of PDPH, but is also ineffective in decreasing the prevalence of intra-operative nausea and vomiting during cesarean section. The treatment is a significant risk factor for the development of PDPH.

Dura-arachnoid lesions produced by 22 gauge Quincke spinal needles during a lumbar puncture

Aims: The dural and arachnoid hole caused by lumbar puncture needles is a determining factor in triggering headaches. The aim of this study is to assess the dimensions and morphological...

Technical aspects and postoperative sequelae of spinal and epidural anesthesia: A prospective study of 3,230 orthopedic patients

Background and Objectives: Major complications after spinal or epidural anesthesia are extremely rare. The occurrence of less serious and transient sequelae and complaints may be underestimated if there is no established organization for the systematic and continuous surveillance of patients after anesthesia. This study was designed to evaluate the possible relationship between various block-related occurrences and the intra- and postoperative side effects and complaints. Methods: This prospective study included 3,230 orthopedic patients operated on under neuraxial block. The block was performed by single-dose (single-shot spinal anesthesia [SPIN], 80.6%), continuous spinal anesthesia (CSA, 10.3%), or combined spinal and epidural anesthesia (CSE, 9.1%) technique. The patient position during surgery and a detailed description of block performance and equipment, as well as all intraoperative problems, were immediately recorded. Every patient was given a standardized questionnaire to be completed and returned after 1 week. Results: The overall incidence of paresthesia was 12.8%, being most frequent during spinal catheter insertion with multiple attempts. Postoperative sensory disturbances (numbness, dysesthesia) occurred unrelated to paresthesia elicited by the puncture or catheterization. The failure rates (SPIN, 1.0%; CSA, 1.5%; and CSE, 1.0%) were quite low. Asystole with successful resuscitation, occurred in 1 patient with CSE but, overall, hemodynamic perturbations were more common with the continuous techniques. On the first postoperative day, decreased sensation of the skin was significantly more frequent after the continuous techniques, still present in 6.5% of SPIN patients, 6.1% of CSA patients, and 17.2% of CSE patients 1 week after surgery. These disturbances were also related to the use of a tourniquet and lateral position of the patient during surgery. The frequency of postdural puncture headache (PDPH) was similar for the different techniques (SPIN, 0.9%; CSA, 1.5%; and CSE, 1.7%). About one third of the patients reported strong postoperative pain on the day after the operation, and 5.6% continued to report this at 1 week. Conclusions: Although sensory changes were quite frequent, they were mild and transient. Rather than having been caused by the anesthetic technique, per se, a “nonanesthetic” reason (position, tourniquet, immobilization) should also be considered as their origin. Sensory disturbances, as well as strong pain for at least a week, were reported by several patients, and to become aware of these problems and improve the quality of treatment, a universal regional anesthesia follow-up system is recommended. Reg Anesth Pain Med 2000;25:488-497.

Subarachnoid anesthesia in young patients: A comparative analysis of two needle bevels

Background and Objectives. This prospective, randomized, double-blind study compares the efficacy of two spinal needles in terms of their performance characteristics and associated perioperative complaints in young patients. Methods. ASA I and II patients aged from 20 to 40 years undergoing lower limb orthopedic surgery were included during a 12-month period. After application of the protocol, 158 patients were recruited. The patients were randomized to two groups: group I: 26-gauge Atraucan (n = 79) and Group II: 27-gauge Whitacre (n = 79). A study was made of the demographic parameters, technical characteristics, and peri- and postoperative complications. Results. No significant differences were found in the technical handling of the needles, number of attempts made to achieve the puncture, or the time required to perform the technique. No technical failures (spinal anesthesia inadequate for the planned surgery) were reported, and the frequency of complications during the procedure was identical in both groups. Frequency of postdural puncture headache (3.8%) or severity and duration showed no difference between the two groups. The overall assessment of postoperative complications revealed similar scores for both needles. Conclusions. Technical handling (ease with which block was performed) of the needles analyzed was extremely easy, showing a high success rate which associated with the similar incidence of complications. Type of bevel does not appear to be a determining factor in the quality or morbidity associated with subarachnoid block when fine-gauge needles are used in young patients.

Frequency of Postdural Puncture Headache with 25-G and 27-G Whitacre and 24-G Sprotte Needles

Frequency of Postdural Puncture Headache with 25-G and 27-G Whitacre and 24-G Sprotte Needles

The frequency of postdural puncture headache in obstetric patients: A prospective study comparing the 24-gauge versus the 22-gauge sprotte needle

Study Objective: To compare the frequency of postdural puncture headache (PDPH) in obstetric patients when using the 24 gauge or the larger 22 gauge Sprotte needle. Design: Prospective, randomized study. Setting: Four hospitals. Patients: 375 ASA physical status I and II cesarean section and postpartum tubal ligation patients. Interventions: Obstetric patients were randomly assigned to receive spinal anesthesia via a midline dural puncture using the 24-gauge or the 22-gauge Sprotte needle. Measurements and Main Results: The rate of PDPH was determined by a postoperative visit by the anesthesiologist as well as questioning patients by telephone 1 week or more after discharge. In the 24-gauge Sprotte needle group (n = 186), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.61%. In the 22-gauge Sprotte needle group (n = 189), 2 mild and 1 moderate PDPHs were reported, for an overall rate of 1.59%. All headaches except 1 resolved within 72 hours with conservative treatment. One patient from the 22-gauge Sprotte needle group required an epidural blood patch. There were no failed blocks in either group. Conclusions: Our results suggest that the 22-gauge Sprotte needle, when compared with the smaller 24-gauge Sprotte needle, can be used in obstetric patients without increasing the frequency of PDPH.