LÜTFİYE PİRBUDAK, METE GÜROL UĞUR, BERNA KAYA UĞUR, Seval KUL, SÜLEYMAN GANİDAĞLI

Evaluation of affecting factors and the effectiveness of treatment in cases with post-dural puncture headache who underwent epidural blood patch

Amaç: Dural ponksiyon sonrası baş ağrısı (DPSB) olguları, katkıda bulunan faktörler, epidural kan yaması (EKY) tedavisi ve tedaviye yanıtları değerlendirildi. Bu çalışmada amacımız EKY uygulanan DPSB olgularını incelemektir. Gereç ve Yöntem: Bu geriye dönük çalışmada, EKY uygulanmak suretiyle tedavi edilen 77 DPSB olgusu dahil edildi. Olgular yaş, cinsiyet, geçirilen operasyonun tipi, kullanılan iğnenin tipi ve çapı, spinal girişim sayısı, EKY uygulaması sırasında radiküler ağrı, sonrasında anal jezi kalitesi ve olgu memnuniyeti açısından değerlendirildi. Bulgular: Yetmiş yedi olgunun (46 kadın, 31 erkek) yaş ortalaması 31.5±11.3 ve en yaygın yapılan cerrahi sezaryan idi; 48 olguda birden fazla girişim yapılmıştı, 37 olguda 22 G, 20 olguda 25 G spinal iğne kullanılmıştı. Baş ağrısı süresi kadın hastalarda orta- lama 3.1±1.3 gün, erkek hastalarda 4.6±1.3 gündü (p=0.020). EKY uygulanan olgularda 10. dakikadan itibaren VAS anlamlı derecede azalırken, olgu memnuniyeti anlamlı olarak arttı (p=0.001). Sadece bir (%1.29) olguda iki defa EKY ye ihtiyaç duyuldu. Geçici radiküler ağrı EKY yönetiminde 17 olguda (%22.07) oldu, ancak 5-10 dk içinde geriledi. Sonuç: DPSBli olgularda EKY özellikle obstetrik olgularda etkin ve güvenilirdir. DPSB semptomlarının kadın hastalarda daha erken görüldüğünü saptadık. Spinal anestezi uygulamalarında 22 G den daha küçük çaplı iğneler tercih edilebilir ve birden çok denemeden özenle kaçınılabilir.

Epidural kan yaması uygulanan dural-ponksiyon sonrası başağrısı olgularında etkileyen faktörler ve tedavi etkinliğinin değerlendirilmesi

Summary Objectives: We evaluated post dural puncture headache (PDPH) cases and the contributing factors and monitored the treat- ment response with epidural blood patch (EBP), and other therapies. Methods: In this retrospective study, 77 PDPH cases treated with EBP were included. Patients were evaluated in terms of age, gender, type of surgery, type and diameter of the needle used for dural puncture, number(s) of dural puncture, onset of punctural headache, any conservative therapies for PDPH, number(s) of EBP application, analgesia quality at the 10th min- ute and 2nd hour after EBP application, and radicular pain during procedure. Results: The mean age of 77 patients (46 female, 31 male) was 31.5 ± 11.3, and the most common surgery performed was cesarean section. More than one attempt was applied in 48 patients. In 37 cases, a 22G spinal needle was used, while a 25 G spinal needle was used in 20 cases. The mean duration of the headache was 3.1 ± 1.3 days for female patients and 4.6 ± 2.3 days for male patients (p=0.020). VAS significantly decreased and patient satisfaction significantly increased after the 10th minute in patients who had EBP (p=0.001). In only one case (2%), the second EBP was needed for pain relief. Transient radicular pain was observed in 17 cases (22.07%) at administration of EBP. Conclusion: In PDPH cases, EBP is an effective and relatively safe method, especially in obstetric patients. We reported that the PDPH symptoms presented earlier in female patients. A preference of a small diameter needle (less than 22 G) and avoid- ance of multiple attempts is important for spinal anesthesia.

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