Mustafa Kemal YILDIRIM, Haci Ömer OSMANOĞLU, Berit GÖKÇE CEYLAN, Füsun EROĞLU

The Comparison of Post-dural Puncture Headache- Frequency and Severity on Cesarean Patients that Spinal Anaesthesia Performed with 25G, 27G and 29G Quincke Needles

Objective: The aim of this study is to compare the frequencyand severity of Post-dural Puncture Headache (PDPH)between the cesarean patients that was spinal anaesthesiaperformed with 25G, 27G and 29G quincke needles.Material-Method: Following the approval of Clinicalresearches local Ethics Committee 60 ASA I-II clinical statuspatients above 18 years that cesarean section was plannedincluded in the study. Patients were ramdomised to threegroups. The spinal anaesthesia was performed with 25Gguided quincke sharp-tipped needle to Group I (n=20), with27G needle in Group II (n=20) and with 29G needle in GroupIII (n=25). General anesthesia was performed in unsuccessfulspinal anaesthesia patients and they were excluded from thestudy. The PDPH, the time and the severity till the secondweek of the operation and was asked and reported. Theseverity was degreed according to Lybecker classification.Results: PDPH was reported on 9 of total 60 patients (15.0%).The distribution was as: 5 patients in Group I (25.0%), 3patients in Group II (15.0%), and 1 patient in Group III(5.0%). Severe PDPH was occurred in 2 patients in GroupI and was not occurred in any patients in Group II and III.There was no significany difference istatistically betweengroups by the means of PDPH.Conclusions: At least for preventing the risk, although thereis no statistically difference between different needle sizes;we think that 29G guided needle may be preferred in theclinical practice if available.

25G, 27G ve 29G Quincke İğneler ile Spinal Anestezi Uygulanan Sezaryen Hastalarında Dura Ponksiyonu Sonrası Başağrısı Sıklığı ve Şiddetinin Karşılaştırılması

Amaç: Bu çalışmanın amacı 25G, 27G ve 29G quincke iğneler ile spinal anestezi uygulan sezaryen hastalarında ameliyat sonrası spinal anesteziye bağlı gelişen Dura Ponksiyonu Sonrası Başağrısı (DPSBA) sıklığını ve şiddetini karşılaştırmak. Materyal-Method: Klinik Araştırmalar Yerel Etik Kurulunun onayı alındıktan sonra, ASA I-II, 18 yaş üzeri elektif sezaryen cerrahisi planlanan 60 hasta çalışmaya alındı. Hastalar randomize olarak 3 gruba ayrıldı. Grup I hastalara (n=20) 25G, Grup II hastalara (n=20) 27G, Grup III hastalara (n=20) 29G (kılavuzlu) quincke keskin uç iğneler kullanılarak spinal anestezi uygulandı. Spinal anestezi başarısız veya yetersiz olan hastalarda genel anesteziye geçildi ve hastalar çalışma dışı bırakıldı. Hastalarda DPSBA gelişip gelişmediği, ağrının süresi ve şiddeti 2. haftaya kadar gerekirse telefonla hastalara dönüş yapılarak sorgulandı ve kayıt altına alındı. DPSBA şiddeti Lybecker sınıflamasına göre derecelendirildi. Bulgular: Toplamda 60 hastanın 9’unda (%15,0) DPSBA oluştu. Grupların kendi içinde dağılımı; Grup I’de 20 hastanın 5’inde (%25,0), Grup II’de 20 hastanın 3’ünde (%15,0), Grup III’de 20 hastanın 1’inde (%5,0) DPSBA oluştu. Grup I’de 2 hastada şiddetli DPSBA olurken Grup II ve Grup III’de şiddetli DPSBA oluşmamıştır. Gruplar arasında DPSBA insidansı açısından istatiksel olarak anlamlı bir fark bulunmadı. Sonuç: Farklı iğne boyutları arasında istatistik olarak fark bulunmasa da DPSBA riskini en azından önlemek için eğer elde edilebiliyor ise klinik pratikte 29 G kılavuzlu keskin uçlu iğne tercih edilebilir

PDF

___

1. Keleş E, Yazgan H, Gebeşçe A, Pakır E. The Type of Anesthesia Used during Cesarean Section Is Related to the Transient Tachypnea of the Newborn. ISRN Pediatr. 2013; 24; 2013: 264340.

2. 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(1): 595- 602.

3. Davoudi M, Tarbiat M, Ebadian MR, Hajian P.Effect of Position During Spinal Anesthesia on Postdural Puncture Headache After Cesarean Section: A Prospective, Single- Blind Randomized Clinical Trial.Anesth Pain Med. 2016; 4: 6(4): e35486

4. Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches. Report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology 2000; 55: 909- 914.

5. Hoefnagel A, Yu A, Kaminski A. Anesthetic Complications in Pregnancy. Crit Care Clin. 2016; 32(1): 1-28.

6. Murtaza G, Khan A, Abbas N, Tariq S.Frequency of postdural puncture headache followıng spınal anaesthesıa for caesarean section: a comparıson between 25-g and 27-g pencıl poınt spınal needles. IntI. Chern. Pharrn. Med. J. 2005; 2(1); 163-l74

7. Syed S, Qayoom N, Naaz S, Mushtaq K, Mir AH, Bijli AH et al. Comparison of post-dural puncture headache- incidence and severity in obstetric patients after spinal anesthesia for caesarean section with 25G and 27G quincke needle. Int J Res Med Sci. 2017; 5(2): 596-600

8. Srivastava V, Jindal P, Sharma JP. Study of post dural puncture headache with 27G Quincke&Whitacre needles in obstetrics/nonobstetrics patients.Middle East J Anaesthesiol. 2010; 20(5): 709-17.

9. Lybecker H, Djernes M, Schmidt JF. Post dural puncture headache: Onset, duration, severity and associated symptoms.An analysis of 75 consecutive patients with PDPH. Acta Anaesth Scand. 1995; 39: 605-12.

10. Purtuloğlu T, Özkan S, Teksöz E, Dere K, Şen H, Yen T et al.[ Comparison of the maternal and fetal effects of general and spinal anesthesia in elective cesarean section]. Gülhane Tıp Dergisi 2008;50: 91-97

11. Mancuso A, De Vivo A, Giacobbe A, Priola V, Maggio Savasta L,Guzzo M et al. General versus spinal anaesthesia for elective caesarean sections: effects on neonatal short-term outcome. A prospective randomised study. J Matern Fetal Neonatal Med. 2010; 23: 1114-8.

12. Tonni G, Ferrari B, De Felice C, Ventura A. Fetal acidbase and neonatal status after general and neuraxial anesthesia for elective cesarean section. Int J Gynaecol Obstet. 2007; 97: 143-6.

13. Kwak KH.Postdural puncture headache.Korean J Anesthesiol. 2017; 70(2): 136-143

14. Gaiser RR. Postdural Puncture Headache: An Evidence- Based Approach. Anesthesiol Clin. 2017; 35(1): 157-167.

15. Katı İ, Demirel CB, Abbasov ÜH, Silay E, Coşkuner, Tokmak Y. [The Effects Of Needle Type On Complications Of Spinal Anesthesia]. Van Tıp Dergisi, 2002; 9: 2

16. Shah A, Bhatia PK, Tulsiani KL. Postdural puncture headache in caesarean section: A comparative study using 25G Quincke, 27G Quincke and 27G Whitacre Needles. Indian J Anesth. 2002; 46(5): 373-77.

17. Ayub F, Ahmad A, Aslam K, Saleem I. Frequency of headache with 25G or 27G quincke needles after spinal anesthesia in patients under going elective cesarean section. Anaesthesıa, Pain&Intensive Care; 2017; 21(2)

18. Neves J, Monteiro G, Almeida J, Brun A, Anna R, Duarte E. Spinal Anesthesia with 27G and 29G Quincke and 27G Whitacre Needles. Technical Difficulties, Failures and Headache. Rev Bras Anestesiol 2001; 51: 3: 196 - 201