<p>Is There An Effect On The Development Of Postdural Puncture Headache Of Dural Punction Made With The Spinal Needle In Three Different Orientations During Spinal Anaesthesia Applied To Pregnant Patients?</p>

Abstract

Background and objectives: Postdural punction headache (PDPH) is a well-known and common complication of spinal anesthesia. The relationship between spinal needle size, configuration and perforation characteristics of the spinal needle and non-essential leak continues to be controversial. Methods: This prospective-randomized study included 300 patients aged 18-45 years who underwent cesarean section under spinal anesthesia. Spinal anesthesia was performed using a 26G Quincke spinal needle in the L3-4, or L4-5 range in the sitting position. Spinal anesthesia was performed with spinal needle sharp tip opening in the Group 1 patients, right or left laterally in Group 2 and caudal in Group 3, transducing the dural fibers transversely to the subarachnoid area, and directing the free opening of the needle to the spine. The patients were visited in the clinic where they were hospitalized at the 24th and 48th hours postoperatively, and phoned on the 3rd and 5th days after discharge, being questioned for PDPH. Results: It was observed that 64% of patients with PDPH developed within the first 24 hrs, 24% between 24 and 48 hrs and 48-72 hrs in 12%. The incidence of PDPH was 14% in Group 1, 8% in Group 2 and 3% in Group 3. This difference between the groups was statistically significant (p: 0.019). The incidence of PDPH was lower in Group 3 than in Group 1 and Group 2. Conclusion: We suggest that when spinal anesthesia is applied in the obstetric patient group if needle opening faces caudal this method will reduce the frequency of PDPH.

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

“…128 Three RCTs that concluded a lower risk of PDPH with cutting needles in parallel bevel orientation to the dural fibers (longitudinal insertion) versus perpendicular orientation (transverse insertion) were identified. [129][130][131] This is also supported by 1 prospective 55 (n=873) and 1 retrospective study (n=92). 132 However, two small RCTs did not support this conclusion.…”

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

“…One of the most important potential complications is postdural puncture headache (PDPH) [ 3 ]. The incidence rate of PDPH after spinal anesthesia is approximately 0.5–2%, while it reaches 45–80% with epidural anesthesia [ 4 – 7 ]. PDPH, which develops after cesarean section, significantly restricts the physical activity of the mother and increases hospital costs by increasing the length of stay [ 8 ].…”