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Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients
BACKGROUND: Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incid...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Kowsar
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335747/ https://www.ncbi.nlm.nih.gov/pubmed/25729658 http://dx.doi.org/10.5812/kowsar.22287523.2159 |
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author | Mosaffa, Faramarz Karimi, Khodamorad Madadi, Firooz Khoshnevis, Seyyed Hasan Daftari Besheli, Laleh Eajazi, Alireza |
author_facet | Mosaffa, Faramarz Karimi, Khodamorad Madadi, Firooz Khoshnevis, Seyyed Hasan Daftari Besheli, Laleh Eajazi, Alireza |
author_sort | Mosaffa, Faramarz |
collection | PubMed |
description | BACKGROUND: Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH. OBJECTIVES: In this study we aimed to compare the incidence of PDPH in the case of median and paramedian approaches in patients undergoing spinal anesthesia for orthopedic operations. PATIENTS AND METHODS: Patients scheduled for orthopedic surgery under spinal anesthesia between 2007 and 2008 were studied in a double-blinded randomized controlled trial. The patients were randomized to receive spinal anesthesia by either a median (n = 75) or paramedian (n = 75) approach through a 25-gauge Crawford needle. No premedication was given, and all patients received 500 mL of normal saline intravenously and 4 mL of 0.5% isobaric Marcaine 30 minutes prior to surgery in both approaches. RESULTS: Fifteen patients (10%) developed PDPH. There was no significant difference in the incidence of PDPH in both groups, with 7 (9.3%) patients in the median approach group versus 8 (10.7%) in the paramedian approach group developing typical PDPH (P = 0.875). However, a significant difference in PDPH incidence (P = 0.041) was observed between females (9; 16.7%) and males (6; 6.3%). CONCLUSIONS: There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males. |
format | Online Article Text |
id | pubmed-4335747 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | Kowsar |
record_format | MEDLINE/PubMed |
spelling | pubmed-43357472015-02-27 Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients Mosaffa, Faramarz Karimi, Khodamorad Madadi, Firooz Khoshnevis, Seyyed Hasan Daftari Besheli, Laleh Eajazi, Alireza Anesth Pain Med Original Article BACKGROUND: Post-dural puncture headache (PDPH) is an iatrogenic complication of spinal anesthesia. Reported risk factors for PDPH include sex, age, pregnancy, needle tip shape and size, bevel orientation, approach and others. Little is known regarding the effect of different approaches on the incidence of PDPH. OBJECTIVES: In this study we aimed to compare the incidence of PDPH in the case of median and paramedian approaches in patients undergoing spinal anesthesia for orthopedic operations. PATIENTS AND METHODS: Patients scheduled for orthopedic surgery under spinal anesthesia between 2007 and 2008 were studied in a double-blinded randomized controlled trial. The patients were randomized to receive spinal anesthesia by either a median (n = 75) or paramedian (n = 75) approach through a 25-gauge Crawford needle. No premedication was given, and all patients received 500 mL of normal saline intravenously and 4 mL of 0.5% isobaric Marcaine 30 minutes prior to surgery in both approaches. RESULTS: Fifteen patients (10%) developed PDPH. There was no significant difference in the incidence of PDPH in both groups, with 7 (9.3%) patients in the median approach group versus 8 (10.7%) in the paramedian approach group developing typical PDPH (P = 0.875). However, a significant difference in PDPH incidence (P = 0.041) was observed between females (9; 16.7%) and males (6; 6.3%). CONCLUSIONS: There is no difference between median and paramedian approaches with respect to PDPH incidence; the paramedian approach is therefore recommended, especially for older patients with degenerative changes in the spine and intervertebral spaces and those who cannot take the proper position. Moreover, the rate of PDPH was found to be significantly higher in females than in males. Kowsar 2011-09-26 2011 /pmc/articles/PMC4335747/ /pubmed/25729658 http://dx.doi.org/10.5812/kowsar.22287523.2159 Text en Copyright © 2011, ISRAPM, Published by Kowsar Corp. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Mosaffa, Faramarz Karimi, Khodamorad Madadi, Firooz Khoshnevis, Seyyed Hasan Daftari Besheli, Laleh Eajazi, Alireza Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients |
title | Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients |
title_full | Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients |
title_fullStr | Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients |
title_full_unstemmed | Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients |
title_short | Post-dural Puncture Headache: A Comparison Between Median and Paramedian Approaches in Orthopedic Patients |
title_sort | post-dural puncture headache: a comparison between median and paramedian approaches in orthopedic patients |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4335747/ https://www.ncbi.nlm.nih.gov/pubmed/25729658 http://dx.doi.org/10.5812/kowsar.22287523.2159 |
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