Postspinal başağrısı

Dural delinme sonrasında görülen başağrısı (PSBA) spinal anestezinin en sık görülen komplikasyonudur, iğne çapı, tipi ve iğnenin yönlendirilmesi gibi pek çok faktör PSBA gelişiminde etkilidir. PSBA'nın postural başağrısı, bulantı, kusma, kulak çınlaması ve görme kayıpları gibi klasik bulguları vardır. Konservatif tedavi uygun hidrasyon, supin pozisyonda yatak istirahati, kafein ve analjezik kullanımını kapsar. Dirençli vakalarda, epidural kan yaması, invazif bir işlem olmasına ve ciddi komplikasy onlar ile sonuçlanabilmesine rağmen en etkili yöntemdir. Son çalışmalar, oksipital sinir bloğunun da PSBA tedavisinde etkin bir yöntem olduğunu bildirmiştir.

Postspinal headache

Post dural puncture headache (PDPH) is one of the most common complications of spinal anesthesia. Multiple factors including needle size, type, and needle bevel orientation have been postulated to contribute to develop PDPH. The presentation of PDPH tends to have classical symptoms that include a postural headache, nausea, vomiting, tinnitus, and ocular disturbances. Conservative treatment approaches include adequate hydration, bed rest in supine position, caffeine and analgesics. In resistant cases epidural blood patch is the most effective treatment although it is an invasive procedure and may result in serious complications. Recent studies showed that occipital nerve block is also an effective method for the treatment of PDPH.

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1. Domenicucci M, Ramieri A, Paolini S, et al. Spinal subarachnoid hematomas: our experience and literature review. Acta Neurochit 2005; 147:741-50.
2. Horlocker TT, Wedel DJ. Infectious complications of regional anesthesia. Best Pract Res Clin Anaesthesiol 2008; 22: 451-75.
3. Simmons SW, Cyna AM, Dennis AT, Hughes D. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev 2007; 18; CD003401.
4. Reamy BV. Post-epidural headache: how late can it occur? J Am Board Fam Med 2009; 22: 202-5.
5. Van Kooten F, Oedit R, Bakker SL, Dippel DW. Epidural blood patch in post dural puncture headache: a randomised, observerblind, controlled clinical trial. J Neurol Neurosurg Psychiatry 2008; 79:553-8.
6. Tohmo H, Vuorinen E, Muuronen A. Prolonged impairment in activities of daily living due to postdural puncture headache after diagnostic lumbar puncture. Anaesthesia 1998; 53: 299-302.
7. Grant R, Condon B, Hart I, Teasdale GM. Changes in intracrani¬al CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry 1991; 54: 440- 2.
8. Carson D, Serpell M. Choosing the best needle for diagnostic lumbar puncture. Neurology 1996; 47: 33-7.
9. Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: part I diagnosis, epidemiology, etiology, and pathophysiology. Headache'2010; 50: 1144-52.
10. Liu H, Kaye A, Comarda, Li M. Paradoxical postural cerebrospinal fluid leak-induced headache: report of two cases. J Clin Anesth 2008; 20: 383-5.
11. Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry 1991; 54: 440- 2.
12. Göbel H, Schenkl S. Post-lumbar puncture headache: the relation between experimental suprathreshold pain sensitivity and quasi-experimental clinical pain syndrome. Pain 1990; 40: 267-78.
13. Mokri B, Atkinson JL, Piepgras DG. Absent headache despite CSF volume depletion (intracranial hypotension). Neurology 2000; 55: 1722-4.
14. Amorim JA, Valença MM. Postdural puncture headache is a risk factor for new postdural puncture headache. Cephalagia 2008; 35:149-57.
15. Frank RL. Lumbar puncture and post-dural puncture headaches: implications for the emergency physician. J Emerg Med 2008; 35: 149-57.
16. Rozen T, Swidan S, Hamel R, Saper J. Trendelenburg position: a tool to screen for the presence of a low CSF pressure syndrome in daily headache patients. Headache 2008; 48: 1366-71.
17. Lavi R, Yarnitsky D, Rowe JM, Weissman A, Segal D, Avivi I. Standard vs atraumatic Whitacre needle for diagnostic lumbar puncture: a randomized trial. Neurology 2006; 67: 1492-4.
18. Ghatge S, Uppugonduri S, Kamarzaman Z. Cerebral venous sinus thrombosis following accidental dural puncture and epidural blood patch. Int J Obstet Anesth 2008; 17: 267-70.
19. Lin W, Geiderman J. Myth: fluids, bed rest, and caffeine are effective in preventing and treating patients with post-lumbar puncture headache. West J Med 2002; 176: 69-70.
20. Clark JW, Solomon GD, Senanayake PD, Gallagher C. Substance P concentration and history of headache in relation to postlumbar puncture headache: towards prevention. J Neurol Neurosurg Psychiatry 1996; 60: 681-3.
21. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth 2003; 91:718- 29.
22. Gaiser R. Postdural puncture headache. Curr Opin Anaesthesiol 2006; 19: 249-53.
23. Vandam LD, Dripps RD. Long-term follow up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties). JAMA 1956; 161:586-91.
24. Lybecker H, Moller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache: a prospective study of 1021 spinal anesthesias. Anesth Analg 1990; 70: 389-94.
25. Flaatten H, Rodt S, Rosland J, Vamnes J. Postoperative headache in young patients after spinal anesthesia. Anaesthesia 1987; 42: 202-5.
26. Tourtellotte WW, Henderson WG, Tucker RP, Gilland O, Walker JE, Kokman E. A randomized, double-blind clinical trial comparing the 22 versus 26 gauge needle in production of the post-lumbar puncture syndrome in normal individuals. Headache 1972; 12: 73-8.
27. Janssens E, Aerssens P, Alliet P, Gillis P, Raes M. Post-dural puncture headaches in children. A literature review. Eur J Pediatr 2003; 162: 117-21.
28. Wu CL, Rowlingson AJ, Cohen SR, et al. Gender and post-dural puncture headache. Anesthesiology 2006; 105: 613-8.
29. 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.
30. Faure E, Moreno R, Thisted R. Incidence of postdural puncture headache in morbidly obese parturients [letter], Reg Anesth 1994;19:361-3.
31. Leibold RA, Yealy DM, Coppola M, Cantees KK. Post-dural puncture headache: characteristics, management, and prevention. Ann Emerg Med 1993; 22: 1863-70.
32. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anest Analg 2000; 91: 916-20.
33. Yilming ST, Kloster R. Post-lumbar puncture headache: clinical features and suggestions for diagnostic criteria. Cephalalgia 1997; 17: 778-84.
34. Weir EC. The sharp end of the dural puncture. BMJ 2000; 320: 127-8.
35. Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of American Academy of Neurology 2000; 55: 909-14.
36. Eede HV, Hoffmann VL, Vercauteren MP. Postdelivery postural headache: not always a classical post-dural puncture headache. Acta Anaesthesiol Scand 2007; 51: 763-5.
37. Goldszmidt E, Kern R, Chaput A, Macarthur A. The incidence and etiology of postpartum headaches: a prospective cohort study. Can J Anaesth 2005; 52: 971-.
38. Stella CL, Jodicke CD, How HY, Harkness UF, Sibai BM. Postpartum headache: is your work-up complete? Am J Obstet Gynecol 2007; 196:318-20.
39. Can OS, Yilmaz AA, Gürcan E, Alkis N, Uysalel A. Is post partum headache after epidural anaesthesia always innocent? Eur J Anaesthesiol 2008; 25: 697-700.
40. Kueper M, Goericke SL, Kastrup O. Cerebral venous thrombosis after epidural blood patch: coincidence or causal relation? A case report and review of the literature. Cephalalgia 2008; 28: 769-73.
41. Ergün U, Say B, Bozbaş A, Kocatürk Ö, İnan L. Post-lomber ponksiyon baş ağrısında teofilinin etkinliği (5 olgunun sonuçları). Türk Nörol Derg 2008; 14: 33-6.
42. Collier CB. Complications of regional anesthesia. In: Birnbach DJ, Gatt SP, Datta S, editors. Textbook of Obstetric Anesthesia. New York: Churchill Livingstone 2000; 504-23.
43. Kuczkowski KM, Benumof JL. Decrease in the incidence of postdural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand 2003; 47: 98-100.
44. Kuczkowski KM. Post dural puncture headache, intracranial air and obstetric anesthesia. Anaesthesist 2003; 52: 798-800.
45. Kuczkowski KM. Post-dural puncture headache in the obsetric patient: an old problem. New solutions. Minerva Anestesiol 2004; 70:823-30.
46. Yaksh TL, Noueihed RY, Durant PA. Studies of the pharmacology and pathology of intrathecally administered 4-anilinopiperidine analogues and morphine in the rat and cat. Anesthesiology 1986; 64: 54-66.
47. Shear T, Ahmed SU. Epidural blood patch for chronic daily headache with postural component: a case report and the review of the published cases. Pain Physician 2008; 11: 77-80.
48. Rathmell JP, Neal JM, Visconi CM. Regional Anesthesiology. The Requisites in Anesthesiology. In Hines RL editor. Philadelphia: Mosby 2004; 145-9.
49. Desai MJ, Dave AP, Martin MB. Delayed radicular pain following two large volume epidural blood patches for post-lumbar puncture headache: a case report. Pain Physician 2010; 13: 257- 62.
50. Boğduk N. The clinical anatomy of the cervical dorsal rami. Spine 1982; 7: 319-30.
51. Naja ZM, El-Rajab M, Al-Tannir MA, Ziade FM, Tawfik OM. Repetitive occipital nerve blockade for cervicogenic headache: expanded case report of 47 adults. Pain Pract 2006; 6: 278-84.
52. Naja Z, Al-Tannir M, El-Rajab M, Ziade F, Baraka A. Nerve stimulator-guided occipital nerve blockade for postdural puncture headache. Pain Pract 2009; 9: 51-8.