Post dural puncture headache is a significant and well known complication of puncture of the duramater. Historical reference to Post dural puncture headache was recorded by August Bier in 1899. There is a direct correlation between needle size and risk of Post dural puncture headache. This study comprised of 200 ASA grade I and II patients between 15 to 74 years of age of both sexes who underwent elective cholecystectomy. After undergoing a thorough preanaesthetic check up each patient received pre-medication one night before surgery and skin sensitivity test was done. Patient was kept nil orally, a baseline pulse rate, blood pressure and oxygen saturation were recorded. Lumbar puncture was done in sitting position at L2-L3 inter vertebral space with Quincke needle (23, 25, 26 G). After assuring a free flow of clear cerebrospinal fluid 4 ml of 0.5 % bupivacaine heavy was injected. After achieving satisfactory block patients were oxygenated by face mask and regular monitoring of pulse rate, blood pressure and oxygen saturation was done and recorded. Statistical analyses was done by applying students 't' test. The mean age of the patient was 41.2 ± 12.2 years and female patients outnumbered their male counterparts (87.5 %). 25G needle was used in maximum number of patients. The incidence of Post dural puncture headache with 23, 25, 26 G was 24.3 %, 9.2 %, 4.1 % respectively. On statistical analysis the Post dural puncture headache was significantly higher with 23G needle as compared to 25 or 26G (p < 0.05). However there is no statistical significance between 25 and 26G needles. The study concluded that the incidence of post dural puncture headache can be reduced to minimum with the use of small sized needles and proper technique of spinal anaesthesia by an experienced anaesthesiologist.

BACKGROUND Knowledge of the recovery profile from a spinal anaesthetic is helpful in predicting time to meeting discharge criteria from an ambulatory surgery center. Upper abdominal surgery takes 2 to 3 hours. Which was previously considered inappropriate for the ambulatory setting, surgery is now being performed on outpatients under spinal anaesthesia. Therefore, it is important for anaesthesiologists to know the recovery profile of Bupivacaine and Bupivacaine with Fentanyl. There is always need of search of such a drug combination which reduces the hospital stay of patient with minimal side effects. This study explores the use of long acting local anaesthetic Bupivacaine and Bupivacaine with Fentanyl for upper abdominal surgery. METHODS 120 patients undergoing upper abdominal surgery were enrolled in a double-blinded clinical trial study. Patients were randomly allocated into two groups. Group A received 17.5 mg (3.5 ml) of Bupivacaine and Group B received Bupivacaine 15 mg and 25 µg of Fentanyl (3.5 ml) as intrathecal drug for spinal anaesthesia. Sensory and motor blockade scores, postoperative pain scores and need of analgesic injection 6 and 12 hours after surgery, postoperative voiding time, and the incidence of hypotension, bradycardia, respiratory depression, and nausea and vomiting were recorded. Ambulation time and discharge from hospital were also recorded. RESULTS Complete analgesia (time from injection to first report of pain) time was more in group BF i.e., 146±8.5 min, and voiding time was also more in group BF i.e., 10.3 hours (618± 34 min), and 3% patients developed pruritus postoperatively. The average time of discharge was same in both groups but need of analgesic was less in group B. Patients in group BF were more comfortable during post-operative period except 2 patients who develops pruritus. CONCLUSIONS Bupivacaine with intrathecal fentanyl 25 µg produces a satisfactory surgical block, significantly decreases the need of analgesic supplementation, but increases the voiding time. early ambulation occurs in this group. There are no side effect of intrathecal fentanyl. It is very good for patients. Thus, overall effect of Bupivacaine and Fentanyl is superior to Bupivacaine alone, apart from positive effects of fentanyl, it decreases the requirement of bupivacaine and has no side effects.