Mustafa Soner ÖZCAN, Mustafa SONER, Servergazi DEVLET

Dura Ponksiyonu Sonrası Baş Ağrısı ve Tedavisi

Dural ponksiyon, farklı birçok disiplin tarafından farklı amaçlar için sık uygulanan bir işlemdir. Anestezi pratiğinde dural ponksiyon en çok istemli olarak subaraknoid blok ve istemeden epidural anestezi sırasında gerçekleştirilir. Dura ponksiyonu sonrası baş ağrısı, August Bier'in 1898'de ilk vakayı bildirmesinden beri bu işlemden sonra ortaya çıkan sık ve ciddi komplikasyonlardan biridir. Son yıllarda geliştirilen küçük çaplı iğneler ve özellikle pencil-point tipi iğnelerde baş ağrısı insidansı geleneksel keskin Quinke tip iğnelere kıyasla oldukça azalmıştır. Baş ağrısı genel olarak 2 hafta içerisinde kaybolsa da, aylar ve hatta yıllarca sürebilir. Hastaların günlük yaşantısını ciddi anlamda bozan bu komplikasyon için değişik tedavi modaliteleri bulunmuştur. Bunlardan güncel olan ''altın standart'' yöntem olarak kabul görülen epidural kan yamasıdır. Dura ponksiyonu sonrası baş ağrısı, farkedildiği andan itibaren dikkatlice izlenmeli, hızlıca tedavisine başlanmalıdır. İnvaziv yöntemler, konservatif yöntemlere cevap vermeyen vakalarda seçilmelidir. Oluşabilecek diğer hayatı tehlikeye sokabilecek komplikasyonlar açısından dikkatli olunmalı ve ayırıcı tanı yapılmalıdır.

Post-Dural Puncture Headache And Treatment

Dural puncture is a common procedure used by many different disciplines for different purposes. In anesthesia practice, dural puncture is mostly performed during subarachnoid block as intentional and epidural anesthesia as unintentional. Post-dural puncture heacache has been one of the most frequent and serious complications since August Bier reported the first case in 1898. In recent years, the incidence of headaches with small gauge needles, especially pencil-point type needles, has been greatly reduced when compared to traditional cutting Quinke type needles. Although headache generally ceases within 2 weeks, it may last for months or even years. Various treatment modalities have been found for this complication that seriously impairs the daily life of the patients. One of the current methods is epidural blood patch which is regarded as 'Gold Standard'. Post-dural puncture headache should be followed up carefully as from the moment that it is noticed, and treatment should be started quickly. Invasive methods shouldbe chosen for the cases who are unresponsive to conservative methods. It should be careful for other life-threatening complications and definitive diagnosis should be made.

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