TY - JOUR
T1 - Post-dural puncture headache
T2 - A comparison between median and paramedian approaches in orthopedic patients
AU - Mosaffa, Faramarz
AU - Karimi, Khodamorad
AU - Madadi, Firooz
AU - Khoshnevis, Seyyed Hasan
AU - Daftari Besheli, Laleh
AU - Eajazi, Alireza
PY - 2011
Y1 - 2011
N2 - 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.
AB - 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.
KW - Orthopedics
KW - Post-dural puncture headache
KW - Spinal anesthesia
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U2 - 10.5812/kowsar.22287523.2159
DO - 10.5812/kowsar.22287523.2159
M3 - Article
C2 - 25729658
AN - SCOPUS:84886718905
SN - 2228-7523
VL - 1
SP - 66
EP - 69
JO - Anesthesiology and Pain Medicine
JF - Anesthesiology and Pain Medicine
IS - 2
ER -