Evaluation of Incidence of Post-Dural Puncture Headache with Maintenance of Sitting Position Immediately After Spinal Anesthesia
International Journal of Anesthesia and Clinical Medicine
Volume 3, Issue 4, July 2015, Pages: 14-16
Received: Aug. 26, 2015; Accepted: Sep. 21, 2015; Published: Oct. 12, 2015
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Authors
Kyu Chang Lee, Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Korea
Dae-Jeong Koo, Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Korea
Won Sang Lee, Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Korea
Hye Young Kim, Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Korea
Yusun Choi, Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Korea
Myeong Jong Lee, Department of Anesthesiology and Pain Medicine, Konkuk University Medical School, Chungju, Korea
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Abstract
Background: In spinal saddle anesthesia, maintaining the sitting position for 3–5 min, to allow for the descent of the injected drug after lumbar dural puncture, minimizes side effects such as blood pressure reduction. However, it also increases cerebrospinal fluid leakage due to the hydrostatic pressure. We investigated the effects of the maintenance of the sitting position after spinal anesthesia on the development of postdural puncture headache (PDPH). Methods: We reviewed all data of patients undergoing spinal anesthesia performed between January 1, 2012 and December 31, 2013 retrospectively. The incidence of PDPH and epidural blood patch administration were investigated after grouping patients into two groups: the SP group (patients were laid down immediately after spinal anesthesia) and the SA group (patients were maintained in the sitting position for 3–5 min before changing to the operating position). Results: There were no cases of severe PDPH or epidural blood patch administration in the SP group. In the SA group, there were four cases (4%) of PDPH, and among these, three cases (3%) required epidural blood patch administration. Conclusions: The maintenance of the sitting position after spinal anesthesia caused a persistent increase in the transdural pressure, resulting in a higher incidence of PDPH compared with patients that were laid down immediately after anesthesia.
Keywords
CSF Leakage, Epidural Blood Patch, Hydrostatic Pressure, Postdural Puncture Headache, Saddle Anesthesia, Sitting Position
To cite this article
Kyu Chang Lee, Dae-Jeong Koo, Won Sang Lee, Hye Young Kim, Yusun Choi, Myeong Jong Lee, Evaluation of Incidence of Post-Dural Puncture Headache with Maintenance of Sitting Position Immediately After Spinal Anesthesia, International Journal of Anesthesia and Clinical Medicine. Vol. 3, No. 4, 2015, pp. 14-16. doi: 10.11648/j.ja.20150304.11
References
[1]
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail's Clinical anesthesiology. 5th ed. New York, McGraw-Hill Companies, Inc. 2013, pp 969-70.
[2]
Kuzman T, Jurjević I, Mandac I, Radoš M, Orešković D, Jednačak H, et al. The effect of body position on intraocular and CSF pressures in the lateral ventricle, and in cortical and lumbar subarachnoid spaces in cats. Acta Neurochir Suppl 2012; 114: 357-61.
[3]
Shah JL. Epidural pressure and postdural puncture headache in the parturient. Int J Obstet Anesth 1993; 2: 187-9.
[4]
Miller RD, Eriksson LI, Fleisher LA, Wiener-Krenish JP, Young WL. Miller's Anesthesia. 7th ed. Philadelphia, Churchill Livingstone.2010, pp 1626-7.
[5]
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC. Clinical anesthesia. 6th ed. Philadelphia, Lippincott. 2009, 583-4.
[6]
Lybecker H, Djernes M, Schmidt TF. Postdural puncture headache (PDPH): Onset, duration, severity, and associated symptoms An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand 1995; 39: 605-12.
[7]
Jones RJ. The role of recumbency in the prevention and treatment of postspinal headache. Anesth Analg 1974; 53: 788-796.
[8]
Carbaat PA, van Crevel H. Lumbar puncture headache: controlled study on the preventive effect of 24 hours’ bed rest. Lancet 1981; 2: 1133-1135.
[9]
Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, Nidhinandana S, Suwantamee J. Comparison of prevalence of post-dural puncture headache between six hour-supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai 2006; 89: 814-20.
[10]
Schmittner MD, Urban N, Janke A, Weiss C, Bussen DG, Burmeister MA et al. Influence of the pre-operative time in upright sitting position and the needle type on the incidence of post-dural puncture headache (PDPH) in patients receiving a spinal saddle block for anorectal surgery. Int J Colorectal Dis 2011; 26: 97-102.
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