Sema ÖNCÜL, MEHMET YILMAZ, Elif GAYGUSUZ ATAR, Osman ESEN, Canan BALCI

KLİNİĞİMİZDEKİ SPİNAL ANESTEZİ UYGULAMALARININ RETROSPEKTİF DEĞERLENDİRİLMESİ

Amaç: Bu çalışmada kliniğimizde spinal anestezi ile opere edilmiş hastaların retrospektif olarak incelenmesi planlanmıştır. Hastaların demograf ik verileri, spinal iğne özellikleri ve deneme sayılarına göre her iki cinsiyette postspinal başağrısı ve belağrısı oranı ortaya konulması planlanmıştır. Yöntem: Spinal anestezi uygulanarak opere edilmiş 360 hasta retrospektif olarak incelendi. Hastalar telef onla aranarak postspinal başağrısı ve belağrısı deneyimleri sorgulandı. Bulgular: Tüm hasta gruplarında %19 PSBA, %9 belağrısı gözlenirken uygulanan iğne türlerine göre PSBA ve belağrısı yönünden istatistiksel olarak anlamlı f arklılık gözlenmedi. Deneme sayılarına göre karşılaştırıldığında tek ponksiyonla spinal anestezi uygulanan hasta grubunda PSBA oranı daha yüksek bulundu (%18). Ortalama %9 olarak tespit edilen bel ağrısında ise f ark izlenmedi. Tüm hasta gruplarında kadınlarda (%23) erkek hastalara göre (%16) daha yüksek PSBA oranı görüldü (p

RETROSPECTIVE ANALYSIS OF SPINAL ANESTHESIA PROCEDURE IN OUR CLINIC

Obj ective: Retrospective analysis of the patients operated under spinal anesthesia in our clinic was aimed to be planned in this study. The incidence of postspinal headache (PSBA) and back pain in both genders were planned to be investigated by means of demographic data of the patients, properties of spinal neddles and number of punction attempts. Method: 360 patients operated under spinal aneshesia were analyzed retrospectively. The patients were called by phone to investigate their postspinal headache and back pain experiences. Results: The incidence f or PSBA and back pain were 19% and 9% respectively in all patient groups, however there were no statistically signif icant diff erences regarding both PSBA and back pain between the needle types used. When compared regarding the number of punctions, PSBA incidence was f ound higher in patients with one punction than others (18%). However, there was no diff erence in the incidence of back pain which was 9% approximately. There was a higher incidence of PSBA in f emales (23%) than males (16%) in all patient groups (p <0.05). When compared according to groups of age, the incidence of PSBA in both male (31%) and f emale (39%) patients were higher in the age group of 18 to 39 years than others (p <0.05). Conclusion: In conclusion, occurrance of PSBA f ollowing spinal anesthesia was f ound to be related to younger age and f emale gender. We suggest that, it may be benef icial to pay attention to predisposing f actors and take required precautions bef ore the procedure to reduce the complication rates in spinal anesthesia.

___

1. Erol A, Topal A, Arbag H, Kilicaslan A, Reisli R, Otelcioglu S. Auditory function after spinal anaesthesia: the effect of differently designed spinal needles. Eur J Anaesthesiol 2009; 26: 416-420.
2. Hess JH. Postdural puncture headache: A literature review. AANA J 1991; 59 :549-555.
3. Vilming ST, Kloster R. Post-lumbar puncture headache: clinical features and suggestions for diagnostic criteria. Cephalalgia 1997; 17 :778-784.
4. Jabbari A, Alijanpour E, Mir M, Bani Hashem N, Rabiea SM, Rupani MA. Postspinal puncture headache, an old problem and new concepts: review of articles about predisposing factors. Caspian J Intern Med 2013; 4: 595-602.
5. Lybecker H, Møller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias. AnesthAnalg 1990; 70: 389-394.
6. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. AnesthAnalg 2000; 91: 916-920.
7. Casati A, D'Ambrosio A, De Negri P, Fanelli G, Tagariello V, Tarantino F. A clinical comparison between needle-through-needle and double-segment techniques for combined spinal and epidural anesthesia. Reg Anesth Pain Med 1998; 23 :390-394.
8. Bedirli N, Akkaya T. Postspinal baş ağrısı. Anestezi Dergisi 2010; 18: 135-140.
9. Ben-David B, Rawa R. Complications of neuraxial blockade. Anesthesiol Clin North America 2002; 20: 669-693.
10. Horlocker TT. Complications of spinal and epidural anesthesia. Anesthesiol Clin North America 2000; 18: 461-485.
11. Lynch J, Krings-Ernst I, Strick K, Topalidis K, Schaaf H, Fiebig M. Use of a 25-gauge Whitacre needle to reduce the incidence of postdural puncture headache. Br J Anaesth 1991; 67: 690-693.
12. Vandam LD, Drıpps RD. Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decrease dintracranial pressure (headache and ocular and auditory difficulties). J Am Med Assoc 1956; 161: 586591.
13. Gibson SJ, Helme RD. Age-related differences in pain perception and report. Clin Geriatr Med 2001; 17: 433-456.
14. Wadud R, Laiq N, Qureshi FA, Jan AS. The frequency of postdural puncture headache in different age groups. J Coll Physicians Surg Pak 2006; 16: 389-92.
15. Sarlani E, Greenspan JD. Gender differences in temporal summation of mechanically evoked pain. Pain 2002; 97: 163-169.
16. Bezov D, Lipton RB, Ashina S. Post-Dural Puncture Headache: Part I Diagnosis, Epidemiology, Etiology, and Pathophysiology. Headache 2010; 50: 1144-1152.
17. Schwabe K, Hopf HB. Persistent back pain after spinal anaesthesia in the non-obstetric setting: incidence and predisposing factors. Br J Anaesth 2001; 86: 535-539.