The effect of epidural needle type on postdural puncture headache: a randomized trial

Morley‐Forster, Patricia; Singh, Sudha; Angle, Pamela; Littleford, Judith; Currin, Michael; Halpern, Stephen H.

doi:10.1007/bf03021847

Cited by 17 publications

(17 citation statements)

References 14 publications

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“…). After the inclusion criteria were applied and hand searches completed, 40 eligible RCTs remained . The details of these RCTs are reported in Appendix S1, and the results of the RCTs are summarised in Tables and .…”

Section: Resultsmentioning

confidence: 99%

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Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Bradbury

Singh

Badder

et al. 2012

Acta Anaesthesiol Scand

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Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions to reduce PDPH following ADP. Multiple electronic databases were searched for randomised clinical trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, and the incidence of at least one of these was recorded. Forty RCTs (n = 11,536 epidural insertions) were included, studying combined spinal-epidurals (CSEs), loss of resistance medium, prophylactic epidural blood patches, needle bevel orientation, ultrasound-guided insertion, epidural morphine, Special Sprotte needles, acoustic-guided insertion, administration of cosyntropin, and continuous spinal analgesia. The RCTs for CSE, loss of resistance medium, and prophylactic epidural blood patches were meta-analysed. Five methods reduced PDPH: prophylactic epidural blood patch {four trials, median quality score = 2, risk difference = -0.48 [95% confidence interval (CI): -0.88 to -0.086]}, lateral positioning of the epidural needle bevel upon insertion (one trial, quality score = 1), Special Sprotte needles [one trial, quality score = 5, risk difference = -0.44 (95% CI: -0.67 to -0.21)], epidural morphine [one trial, quality score = 4, risk difference = -0.36 (95% CI -0.59 to -0.13)], and cosyntropin [one trial, quality score = 5, risk difference = -0.36 (95% CI -0.55 to -0.16)]. Several methods potentially reduce PDPH. Special Sprotte needles, epidural morphine, and cosyntropin are thus far each supported by a single, albeit good quality trial. Prophylactic blood patches are supported by three trials, but these had flawed methodology. Mostly, trials were of limited quality, and further well-conducted, large studies are needed.

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Section: Resultsmentioning

confidence: 99%

“…The other five interventions, Special Sprotte epidural needle, acoustic device, continuous spinal analgesia, epidural morphine, and cosyntropin, were each investigated by only one published RCT.…”

Section: Resultsmentioning

confidence: 99%

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Bradbury

Singh

Badder

et al. 2012

Acta Anaesthesiol Scand

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“…[1][2][3] Cette technique, lors de laquelle une brèche produite par une aiguille de gros calibre peut survenir, est quasi-inexistante dans notre établisse-ment; elle se heurte à la réticence des femmes qui, pour des raisons d'ordre culturel, préfèrent accoucher dans la douleur. Nous rapportons une série de cas de céphalées qui font suite à une rachianesthésie pour césarienne, donc à une ponction durale effectuée avec des aiguilles de taille plus réduite.…”

Section: Au Rédacteur En Chefunclassified

Traitement des céphalées post-rachianesthésie en milieu africain

Zué

Ntamack

Biyogo

2009

Can J Anesth/J Can Anesth

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Au rédacteur en chef,En obstétrique, les céphalées sont le plus souvent liées à une brèche accidentelle de la dure-mère lors de l'analgésie péridurale pour le travail. 1-3 Cette technique, lors de laquelle une brèche produite par une aiguille de gros calibre peut survenir, est quasi-inexistante dans notre établisse-ment; elle se heurte à la réticence des femmes qui, pour des raisons d'ordre culturel, préfèrent accoucher dans la douleur. Nous rapportons une série de cas de céphalées qui font suite à une rachianesthésie pour césarienne, donc à une ponction durale effectuée avec des aiguilles de taille plus réduite. Le traitement des céphalées secondaires à la ponction de la dure-mère repose sur l'administration péridurale de sang autologue ou « blood patch ». 4 Les résultats de cette modalité de traitement dans notre maternité sont également rapportés.Entre le 1 er janvier 2006 et le 31 décembre 2008, 720 parturientes ont bénéficié d'une césarienne effectuée sous rachianesthésie utilisant les aiguilles Spinocan 22G (450 patientes) et celles de Whitacre 25G (270 patientes). Cinquante-six patientes (7,7 %) ont présenté secondairement des céphalées dont les symptômes étaient caractéristiques d'une fuite de liquide céphalorachidien. Ces céphalées se retrouvaient plus souvent chez les patientes du groupe Spinocan (49/450 ou 10,9 %) que chez celles du groupe Whitacre (7/270 ou 2,6 %). Chez neuf patientes, soit 16 % de celles qui se sont plaintes de céphalées, un traitement par le blood patch a été décidé devant la sévérité des symptô-

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“…adverse health outcomes can result that include: spinal headaches [9][10][11][12], hematoma [13][14][15][16], paralysis [17][18][19][20][21], and pneumothorax [22,23]. X-ray-based imaging, such as real-time fluoroscopy, is known to significantly increase success rates.…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional spinal bone imaging with medical ultrasound for epidural anesthesia guidance

Mauldin

Owen

Hossack

2011

2011 IEEE International Ultrasonics Symposium

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Epidural anesthesia procedures are performed in approximately 75 percent of all childbirths in the United States; however, failure rates for these procedures are as high as 40 percent across all cases and 70 percent in the obese population. Due to the limitations associated with X-ray-based fluoroscopy, including exposure to ionizing radiation and lack of portability, the standard of care is to perform epidurals using palpation -i.e. without medical imaging. High-quality 3D imaging of spinal bone surfaces, obtained using a portable ultrasound device, could potentially overcome these challenges and offer physicians a safe imaging tool to increase success rates. A 4-channel handheld ultrasound system with custom 0.95 cm diameter piston transducers focused at 5 cm were designed and fabricated. The system was then used to image an excised lumbar spine in a water bath over a mechanically scanned 90 mm x 50 mm 2D plane. Positional information regarding the surface of the lumbar spine bone at each point across the 2D plane was estimated in MATLAB by detecting the position of maximum envelopedetected signal above the noise level. 3D topographical images were rendered and qualitatively compared to photographs of the actual spine. Additionally, 3D printed models of anatomically accurate lumbar vertebrae were fabricated and embedded in a graphite gelatin phantom. Imaging was conducted with a mechanically scanned 5 MHz piston transducer, 3D images were formed, and the correlation between the known surfaces and ultrasound estimated surfaces was computed. Images of the excised spine using the handheld ultrasound system yielded excellent correlation to optical images. Automated measurements (performed in MATLAB) of spinous process and epidural gap dimensions across the axis of the spine were within 0.5 mm of the actual dimensions. 3D images of the printed spine model produced a 0.88 correlation coefficient between estimated and true spine surface locations. Results in this paper demonstrate the feasibility of a handheld ultrasound device for low-cost, safe, and portable imaging of spinal bone anatomy in 3D, which possesses the potential for improving the success rates of epidural anesthesia procedures. Index Terms-epidural, spine, three-dimensional imaging, ultrasoundAll authors are with the

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The effect of epidural needle type on postdural puncture headache: a randomized trial

Abstract: Résultats LCR (1.8 % Tuohy, 3.4 % Sprotte, P = 0,12

Cited by 17 publications

References 14 publications

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Traitement des céphalées post-rachianesthésie en milieu africain

Three-dimensional spinal bone imaging with medical ultrasound for epidural anesthesia guidance

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