Incidence Of Post-spinal Headache Research Articles

A STUDY OF POST DURAL PUNCTURE HEADACHE AFTER USING FINE GAUGE SPINAL NEEDLE IN SUBARACHNOID BLOCK

J. Leonard Corning1 a neurologist of New York was the rst one to give recorded but accidental spinal anesthesia in 1885 when he pierced the dura while experimenting with cocaine on spinal nerves of a dog. According to International headache society the criteria dened for Post Dural Puncture Headache (PDPH) includes a headache that develops in less than seven days after a spinal puncture, occurs or worsens in less than fteen minutes after assuming upright position and improves in less than thirty minutes after assuming recumbent position with at least one of the following associate (neck stiffness, tinnitus, hypacusia, photophobia and nausea). The headache usually resolves within fourteen days after spinal puncture. In the present study we analyzed the incidence of post spinal headache after using narrow gauge atraumatic needles irrespective of administrator's status. We also analyzed to relate the skill of administration to the incidence of headache. Majority of the patients 1094 (88.58%) included in this study were between the ages of 20 to 60 years, while 63 (5.11%) were below 20 years and 78 (6.31%) were above 60 years of age. Of the 1235 patients included in the study 429(34.74%) patients were male and 806(65.26%) were females. Of the 1235 patients 515 females underwent surgery for obstetric reasons mostly L.S.C.S and rest underwent non obstetric surgeries. Overall PDPH rate observed in 1235 cases was 2.8% i.e. 35 patients had PDPH after using ne gauge spinal needle. Out of these 35 patients who reported having PDPH; in 21 patients (60%) was administered spinal anesthesia using 26G needle and 14 patients were given spinal block with 25G needle. The incidence of PDPH seems higher with 26G needle as most of the patients in our institution receives spinal anesthesia using 26G needle. . Of the 35 cases included reporting having PDPH, trauma occurred in only 6 cases i.e. 17.14% and in rest of the cases LP was atraumatic. 23 out of 35 (65.71%) patients lumbar puncture was done in rst pass in single interspace only, in 5 patients (14.28%) more than one attempt was required but attempts were taken in single interspace with single skin puncture only, in 3 patients (8.57%) more than one attempt accompanied by one skin puncture in one interspace only and lastly in 4 patients (11.42%) multiple attempts in multiple spaces was done. Thus above observations clearly establishes that PDPH occurred more frequently in female in the age group of 20-40 years and majority of them underwent obstetric surgery.

English

BACKGROUND Spinal anaesthesia is the first preference of anaesthesia in obstetric surgery. Post dural puncture headache (PDPH) is more common after C-section in young parturients. In the present world which is developing and fast-paced, brisk recovery along with minimal side effects & importantly early ambulation are now the need of the hour. This headache is more worrying to the mother who is required to tend to the newborn baby. This study compared the incidence of PDPH subsequent to subarachnoid blockade for lower segment Caesarean section (LSCS) 25G Whitacre & 25G Quincke needles. We wanted to compare the incidence of PDPH using 25G Quincke and 25G Whitacre spinal needles in patients undergoing LSCS. METHODS Two hundred (ASA II) American Society of Anaesthesiologists 11 females who were pregnant and in the age group of 20 - 50 years, planned to get sub-arachnoid blockade for C-section, were assigned randomly into two equal groups (N = 100 each). Both groups received spinal anaesthesia with 25-gauge Quincke and 25 gauge Whitacre needle. Postoperatively, incidence, site, onset, severity and duration of headache was studied. RESULTS The incidence of post spinal headache was 6 % in the Quincke group. No patients in Whitacre group had PDPH. The number of lumbar punctures required for successful sub arachnoid block was recorded in both the groups. 92 % patients from group Q and 88 % patients from group W required only one puncture. 8 % patients from group Q and 12 % patients from group W required two punctures. CONCLUSIONS It is prudent to conclude that 25G Whitacre spinal needle is a better alternative to 25G Quincke needle for reducing the incidence of post dural puncture headache in patients undergoing lower segment Caesarean section. KEY WORDS Spinal Anaesthesia, Post Dural Puncture Headache, Caesarean Section

THE EFFECT OF SUNTHYADI PHANT IN POST-SPINAL HEADACHE A PRILIMINARY CLINICAL STUDY

Abstract- 
 The spinal anesthesia is frequently performed procedure in surgical field, Headache after spinal anesthesia is common which accounts for 32% prevalence and carries considerable morbidity with the symptoms lasting for several days.
 As working in surgical field there is more incidence of post spinal headache after spinal anesthesia, post spinal headache is well known complication. It occurs after Induction of spinal anesthesia due to leakage of CSF after the Dural and arachnoid puncture and has significant effect on the patient’s post-operative well-being.
 The present study aimed to evaluate the “Effect of Sunthyadi Phant on preventing post spinal Headache” in surgical patients.

Incidence of Postspinal Headache and Low Backache Following the Median and Paramedian Approaches in Spinal Anesthesia.

Background and Aims:Postspinal headache and low backache are common complaints following spinal anesthesia which regresses spontaneously but sometimes becomes very troublesome for the patient as well as for the anesthesiologists. The aim of this study was to evaluate the incidence of postspinal headache and low backache after spinal anesthesia in lower abdominal surgery.Materials and Methods:One hundred patients of 18–60 years of age group with patients physical status the American Society of Anesthesiologists Class I or II after due consent divided into equal numbers of two groups: median (M) approach and paramedian (P) approach scheduled for lower abdominal surgery. Group M (50 patients) received spinal by median approach while in Group P (50 patients) received spinal by paramedian approach. The incidence of postspinal headache and low backache was observed in each group. All the patients were observed up to 7 days postoperatively. Data collected was analyzed statistically by SPSS (IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp) and Chi-square test, and P < 0.05 considered as statistically significant.Results:Postspinal headache was observed to be 4% in paramedian approach and 20% in median approach group. Backache incidence recorded in both the groups was 2% and 10%, respectively. P value calculated statistically was < 0.05 and hence statistically significant in paramedian approach in respect of incidence of both postspinal headache and backache.Conclusion:Incidence of postspinal headache and low backache is less in paramedian approach than in median approach.

Ondansetron 8 mg and 4 mg with normal saline against post-operative headache and nausea/vomiting after spinal anesthesia: a randomized double-blind trial

The study aims to evaluate the efficacy of ondansetron in preventing post-spinal headache, considering the high prevalence of the headache in pregnant women and the common use of the adjuvants for prophylaxis against post-operative nausea and vomiting (PONV). This double-blind clinical trial included the 195 patients who were referred to Taleghani Hospital (in Arak, Iran) for cesarean section (C/S) under spinal anesthesia, and then the subjects were assigned to three equally sized groups using block randomization. Participants in the first, second, and control groups received 8 mg, 4 mg of ondansetron, and normal saline, respectively, 5 minutes before surgery. A final volume of 5 cc was prepared by adding normal saline. Participants were examined for headache one week after surgery, and then data analysis was performed using SPSS 20. The incidence of post-spinal headache was significantly higher in the placebo group than in the ondansetron 8-mg and 4-mg groups at 24 hours after surgery (P < 0.010). But, no significant difference was observed between two ondansetron groups (P ≤ 0.05). The overall incidence of the headache was generally lower in ondansetron 8-mg (26.66% vs. 33.68.05%) and 31.66% in ondansetron 4-mg (P < 0.001). Moreover, the PONV incidence was significantly higher in the placebo group than in the other two groups at 24 hours (P < 0.001). The hemodynamic variables were same in three groups. The ondansetron 8-mg dose can be effective to prevent headache after spinal anesthesia for C/S. Moreover, the ondansetron 8-mg and ondansetron 4-mg have same effect in control of PONV after spinal anesthesia for C/S.

Post-spinal Headache after Caesarean Section – Effect of Approach Into Dura-Arachnoid Sac

Introduction : Spinal anaesthesia is the technique of choice for caesarian section. But post-spinal headache (PSH) is still a ‘headache’ for the anaesthesiologist even after using modern spinocaine needles.Objective : This study was performed to compare the incidence of PSH between midline and lateral approach when caesarian sections were done by spinal anaesthesia.Methods : After ethical clearance this study was done in Chittagong Medical College Hospital. Two hundred pregnant women of American Society of Anesthesiologists (ASA) physical status I &amp; II who underwent caesarian section were included and randomized into 2 groups. After informed consent spinal needle were inserted by midline approach in Group A patients and by lateral approach in Group B patients. After appearance of free flow of CSF 0.5% hyperbaric bupivacaine 10 mg was injected to each patient. PSH and other complications were evaluated.Results : Incidence of PSH was significantly higher in Group A patients.Conclusion : Lateral approach during spinal anaesthesia is better than midline approach in preventing PSH.J Bangladesh Coll Phys Surg 2017; 35(3): 123-127

Effect of intrathecal fentanyl on incidence of post-spinal headache

Effect of intrathecal fentanyl on incidence of post-spinal headache

The effect of intravenous propofol on the incidence of post-dural puncture headache following spinal anesthesia in cesarean section

Introduction: Post Dural puncture headache is still a common complication among young women undergone cesarean section, although use of small size spinal needles reduced its prevalence. Several methods have been suggested for prevention and treatment of this side effect; such as complete bed rest, hydration, non-opioid analgesics, caffeine, codeine, which none of them proved to be totally effective. The last option would be epidural blood patch, if headache persist. The aim of this study was evaluation the efficacy of intravenous propofol on post dural puncture headache incidence after cesarean section. Methods: In a randomized clinical trial 120 patients aged 18-45 years old in American Society of Anesthesiologist (ASA) class I or II, who had no history of headache, analgesic consumption, substance abuse and drug addiction, candidate for elective cesarean section, were randomly assigned into intervention (propofol) and control groups. The anesthesia method for both groups was precisely the same. After spinal anesthesia in the first group 30µg/kg/min of intravenous propofol have been infused slowly. Then at 1, 6, 18, 24 hours and 2nd to 7th days after surgery, anesthesiologist asked groups for presence or absence of headache. The data analyzed with SPSS 16.0 software. Results: Headache incidence rate in the group who receiving propofol was significantly reduced (P.V=0.001). Conclusion: This study showed that 30µg/kg/min of intravenous propofol caused reduced the incidence of post spinal headache in young women undergone elective cesarean section. � Supportive interventions must be considered as an indispensable part of care for children with cancer.

Two percent lidocaine spinal anaesthesia compared with sevoflurane anaesthesia in ambulatory knee surgery – cost-effectiveness, home readiness and recovery profiles

A total of 60 patients scheduled for elective knee arthroscopy were randomized to receive spinal anaesthesia (SA) with 2% lidocaine (n=30) or general anaesthesia with sevoflurane (SE) (n=30). SA and SE were compared in terms of the total costs of anaesthesia. The time to reach home readiness and the total time spent in the recovery unit (RU) were assessed. The early postoperative period and recovery at 24 h and 1 week were evaluated in terms of the incidence of pain, sedation, nausea and general satisfaction with the method of anaesthesia and postoperative instructions. The total costs of anaesthetic materials in the operation theatre (OT) and anaesthetic materials and personnel costs until home readiness was achieved in the RU were 160.7 FIM (1 FIM=0.17 EUR) for SA and 171.0 FIM for SE (not significant). The corresponding sums were 197.2 FIM for SA and 224.4 FIM for SE (P=0.001) when the total stay in RU was considered. The time to reach home readiness was 140.8 min (S.D. 52) in the SA group and 96.4 min (S.D. 62) in the SE group (P=0.02). There were no differences in the total RU time (224.0 min (S.D. 67) for SA and 218.0 min (S.D. 59) for SE). The level of postoperative pain was generally low, as all the SA patients and 86.7% of the SE patients had VAS<4 2 h postoperatively. Six SA patients (20.0%) had postoperative headache and two of them also had headache in the supine position. There were no headaches in the SE group (P=0.024). None of the patients in the SA group and six SE patients (20.0%) had nausea (needed treatment) in the RU (P=0.024). Four patients (13.3%) in the SE group and 1 patient (3.3%) in the SA group had nausea during the first 24 h postoperatively. All the patients were alert 60 min postoperatively with no difference between the groups and they were very satisfied during the first 24 h. All patients would have liked to have a similar operation done on an ambulatory basis. 93.3% said they would choose the same kind of anaesthesia. 91.7% were satisfied with the first week.General anaesthesia with SE is more cost-effective than SA with 2% lidocaine in ambulatory knee surgery if a short RU time is needed. The patients do generally well, but the incidence of postspinal headache with SA, adequate postoperative pain treatment and the possibility to have nausea with SE must be kept in mind.

Restricted Spinal Anaesthesia for Ambulatory Surgery: A Pilot Study

KUUSNIEMI, K. S.; PIHLAJAMÄKI, K. K.; IRJALA, J. K.; JAAKKOLA, P. W.; PITKÄNEN, M. T.; KORKEILA, J. E. Author Information

COMBINED SPINAL AND EPIDURAL ANAESTHESIA FOR ABDOMINAL SURGERY: A NEW TECHNIQUE

Combined spinal and epidural anaesthesia was used in 50 patients undergoing abdominal surgery. A fixed dose of 1.0 mL of 5 per cent lignocaine was injected intrathecally in all cases followed by 10 mL of 0.5 per cent bupivacaine epidurally, using "needle through needle" technique in the same lumbar intervertebral space. Subsequently epidural catheter was passed for top-up doses and postoperative analgesia. The advantages of this technique observed were immediate onset of intense block of prolonged, controllable duration and no incidence of post-spinal headache. Five cases developed intraoperative hypotension which required correction. No patient developed any complications of spinal and epidural anaesthesia.

Extradural and subarachnoid catheterization using the Seldinger technique

The Seldinger technique was developed using a plastic introducer through which introduction and manipulations of a silicone spinal catheter, an extradural stimulation lead or a small diameter fibreoptic scope are possible without the risk of damage to the vulnerable devices. It is not intended as a replacement of the standard technique of introducing a spinal catheter through a Tuohy needle in general anaesthetic practice. Silicone spinal catheters and stimulation leads are used for long-term therapy in intractable chronic pain and spasticity. A fibreoptic scope is used for endoscopic examination of the subarachnoid or extradural space. Using a standard Tuohy needle the soft silicone extradural lead can be damaged easily by manipulations during insertion. For this reason the manufacturer modified the Tuohy needle for extradural silicone lead introduction. The disadvantages of this modified Tuohy needle are: first, difficulty in localization of the extradural space, second, the needle is unsuitable for a subarachnoid catheter or introduction of a fibreoptic scope. The Seldinger technique was performed 25 times in 18 patients, introducing a spinal silicone catheter (n = 14), an extradural silicone stimulation lead (n = 2) or a small diameter fibreoptic endoscope (n = 9). Paraesthesiae caused by neural irritation occurred in awake patients. This did not differ from the technique using a Tuohy needle only. Neural damage or trauma did not occur with the Seldinger technique. The incidence of post-spinal headache was the same for both techniques. No further complications were noted.

婦人科手術における術後頭痛について 脊椎麻酔後頭痛の発生頻度

婦人科手術における術後頭痛について 脊椎麻酔後頭痛の発生頻度

Whitacre 22-gauge Pencil-point Needle for Spinal Anaesthesia. A Controlled Trial in 300 Young Orthopaedic Patients

In a prospective study of 300 young orthopaedic in-patients (less than 40 years) given spinal anaesthesia through a 22-gauge Whitacre (n = 150) or a 25-gauge Quincke spinal needle (n = 150), we found a 5.3% and a 9.3% incidence of post-spinal headache (PSH) respectively. Females (10.6%) had a higher overall incidence of post-spinal headache than males (5.6%) with more than twice as many females being affected in the 25 than in the 22-gauge group (14.5% vs 6.1%). The average duration of post-spinal headache was less in the 22-gauge group (36 h vs 42.4 h) as was the incidence of severe headache. It is concluded that the Whitacre 22-gauge needle is more suited for spinal analgesia in young female patients due to its ease of handling and its lower incidence of post-spinal headache.

Spinal Anaesthesia in Day-Care Surgery with a 26-Gauge Needle

We studied 106 day-care surgical patients (52 male) aged 18–70 yr (mean 49.6 yr) who received spinal anaesthesia with a 26-gauge spinal needle. The incidence of headache, back pain and patient acceptability were investigated after operation using a questionnaire. The incidence of postspinal headache was 7.5%, and 11.3% of patients developed back pain. One patient remained in hospital because of hypotension and dizziness. There were no major complications and patient acceptability was almost 100%. We conclude that spinal anaesthesia for day-care surgery is easy to perform and cost effective.

Epidural and spinal (subarachnoid) anaesthesia for Caesarean section

Regional anaesthesia for Caesarean section is increasing in popularity — a trend encouraged by obstetric anaesthetists because of its greater safety and the emotional benefits tomother and baby. Such anaesthesia is easier to provide for elective cases, but even in the case of many emergency or semi-emergency Caesarean sections there may be time to extend an epidural already in use, or to use spinal anaesthesia. The reason for the difficulty in providing effective epidural anaesthesia in some cases has been clarified with the identification of variable bands and septa in the epidural space. Spinal block gives more reliable anaesthesia but carries a higher risk of hypotension so that monitoring to detect, and measures to prevent it must be particularly rigorous. Two new developments which are likely to play a part in improving regional anaesthesia for Caesarean section and post-operative pain relief are continuous spinal and combined spinal-epidural techniques. In the case of the former, particular interest is being focused on very fine microcatheters, but the incidence of post-spinal headache with larger catheters is also being reassessed. The combined technique gives the speed of onset and reliability of the spinal block with the flexibility of analgesia provided by the epidural catheter, as well as the advantage of the Tuohy needle acting as guide for the very fine spinal needles.

SPINAL ANAESTHESIA IN DAY-CARE SURGERY WITH A 26-GAUGE NEEDLE

We studied 106 day-care surgical patients (52 male) aged 18-70 yr (mean 49.6 yr) who received spinal anaesthesia with a 26-gauge spinal needle. The incidence of headache, back pain and patient acceptability were investigated after operation using a questionnaire. The incidence of postspinal headache was 7.5%, and 11.3% of patients developed back pain. One patient remained in hospital because of hypotension and dizziness. There were no major complications and patient acceptability was almost 100%. We conclude that spinal anaesthesia for day-care surgery is easy to perform and cost effective.

Intrathecal anaesthesia for day‐care surgery A retrospective study of 160 cases using 25‐ and 26‐gauge spinal needles

The records of 160 day-care surgical patients who received intrathecal anaesthesia were reviewed. No major complications were recorded. The incidence of postspinal headache after puncture with a 25-gauge spinal needle was nearly four times more frequent compared to a 26-gauge needle. The occurrence of postspinal headache in patients over the age of 45 years was significantly less frequent (p less than 0.05) than in younger patients. Intrathecal anaesthesia was acceptable to 91% of outpatients in this group.

Directional Spinals in Obstetric Analgesia

Directional characteristics of spinal injections delivered via a 22 gauge Whitacre needle were confirmed in twenty-one obstetric patients undergoing elective Caesarean section. Caudad injection was inadequate for elective Caesarean section, while cephalad or lateral injection provided good sensory levels for the duration of the surgery. It is speculated that along with the low incidence of postspinal headache and ease of administering the block with a more rigid 22 gauge needle, low dose caudally directed injections may provide a superior means of administering saddle block analgesia for obstetric patients.

Letter: The prophylactic epidural blood patch.

To the Editor.— Considering the successes claimed for the epidural blood patch (EBP) in curing postspinal headache (PSH), it seemed logical that prophylactic instillation of autologous blood into the epidural space immediately following dural puncture might stave off this unpleasant complication. Immediately after intrathecal injection of the spinal anesthetic, gentle traction was exerted on the syringe plunger, and the spinal needle gradually withdrawn. As soon as spinal fluid ceased to be aspirated, the needle was stopped in place—the assumption being that it was just outside the dura and thus in the epidural space. Two milliliters of autologous blood or 7 ml of normal saline solution (NSS) was instilled. Paired studies were carried out—one autologous blood to one NSS. Since the incidence of PSH increased with bigger-gauge spinal needles, 1 a 20-gauge, disposable spinal needle was used in all cases. Observation was carried out for three days, and if headache occurred