POST-DURAL PUNCTURE HEADACHE: A COMPARISON BETWEEN MEDIAN AND PARAMEDIAN APPROACHES IN ORTHOPEDIC PATIENTS

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MOSAFFA FARAMARZ; KARIMI KHODAMORAD; MADADI FIROOZ; KHOSHNEVIS SEYYED HASAN; DAFTARI BESHELI LALEH; EAJAZI ALIREZA

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Journal: Anesthesiology and Pain Medicine Year:2011 | Volume:1 | Issue:2 (2) Page(s): 66-69

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Title

POST-DURAL PUNCTURE HEADACHE: A COMPARISON BETWEEN MEDIAN AND PARAMEDIAN APPROACHES IN ORTHOPEDIC PATIENTS

Author(s)

Keywords

POST-DURAL PUNCTURE HEADACHE

SPINAL ANESTHESIA

ORTHOPEDICS

Abstract

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.

Cites

LEVOBUPIVACAINE FOR SPINAL ANESTHESIA IN CHILDREN: CEREBROSPINAL FLUID ASPIRATION BEFORE THE INJECTION DOES NOT AFFECT THE SPREAD OR DURATION OF THE SENSORY BLOCK

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APA: Copy

MOSAFFA, FARAMARZ, KARIMI, KHODAMORAD, MADADI, FIROOZ, KHOSHNEVIS, SEYYED HASAN, DAFTARI BESHELI, LALEH, & EAJAZI, ALIREZA. (2011). POST-DURAL PUNCTURE HEADACHE: A COMPARISON BETWEEN MEDIAN AND PARAMEDIAN APPROACHES IN ORTHOPEDIC PATIENTS. ANESTHESIOLOGY AND PAIN MEDICINE, 1(2 (2)), 66-69. SID. https://sid.ir/paper/328391/en

Vancouver: Copy

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. ANESTHESIOLOGY AND PAIN MEDICINE[Internet]. 2011;1(2 (2)):66-69. Available from: https://sid.ir/paper/328391/en

IEEE: Copy

FARAMARZ MOSAFFA, KHODAMORAD KARIMI, FIROOZ MADADI, SEYYED HASAN KHOSHNEVIS, LALEH DAFTARI BESHELI, and ALIREZA EAJAZI, “POST-DURAL PUNCTURE HEADACHE: A COMPARISON BETWEEN MEDIAN AND PARAMEDIAN APPROACHES IN ORTHOPEDIC PATIENTS,” ANESTHESIOLOGY AND PAIN MEDICINE, vol. 1, no. 2 (2), pp. 66–69, 2011, [Online]. Available: https://sid.ir/paper/328391/en

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