Shivan Mishra, Smita Prakash, Parul Mullick, Keshaban Mishra
Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
Indian J Anaesth. 2020 Nov;64(11):971-978. doi: 10.4103/ija.IJA_1080_20. Epub 2020 Nov 1.
Post dural puncture headache (PDPH) following caesarean delivery (CD) is a cause for concern for anaesthesiologists. We aimed to study the effect of reinsertion of the stylet after spinal anaesthesia procedure, prior to spinal needle removal, on the incidence of PDPH in women undergoing CD. We also evaluated the risk factors associated with PDPH.
In this randomised, double-blind study in a tertiary care hospital, 870 American Society of Anesthesiologists (ASA) II/III women undergoing CD under spinal anaesthesia were randomly divided into-GroupA (n = 435): stylet reinsertion before spinal needle removal and Group B (n = 435): spinal needle removal without stylet reinsertion. All patients were questioned for occurrence of PDPH at various time-points. Statistical calculations were done using Statistical Package for the Social Sciences (SPSS) 17 version program for Windows.
Sixty-two (7.1%) patients developed PDPH; 27 (6.2%) patients with stylet reinsertion and 35 (8.0%) patients in those with no stylet reinsertion; = 0.389. The onset of headache was significantly delayed in patients with stylet reinsertion (16.2 ± 6.7 and 13.2 ± 4.3 h, respectively); = 0.041 and they had greater severity of PDPH compared with those with no stylet reinsertion; = 0.002. Factors significantly associated with PDPH were hypothyroidism, tea habituation, number of skin punctures and needle redirections, first pass success rate, occurrence of paraesthesia and contact with bone, intraoperative hypotension and time to ambulation.
Reinsertion of the stylet before spinal needle removal did not influence the incidence of PDPH. The onset of PDPH was delayed and the severity of headache was greater in women in whom reinsertion of the stylet was done.
剖宫产术后硬膜穿刺后头痛(PDPH)是麻醉医生关注的问题。我们旨在研究在剖宫产手术的脊髓麻醉过程中,于拔除脊髓穿刺针之前重新插入针芯对PDPH发生率的影响。我们还评估了与PDPH相关的危险因素。
在一家三级护理医院进行的这项随机、双盲研究中,870例接受脊髓麻醉下剖宫产手术的美国麻醉医师协会(ASA)II/III级女性被随机分为A组(n = 435):在拔除脊髓穿刺针之前重新插入针芯;B组(n = 435):不拔除针芯直接拔除脊髓穿刺针。在不同时间点对所有患者询问PDPH的发生情况。使用适用于Windows的社会科学统计软件包(SPSS)17版程序进行统计计算。
62例(7.1%)患者发生了PDPH;重新插入针芯的患者中有27例(6.2%),未重新插入针芯的患者中有35例(8.0%);P = 0.389。重新插入针芯的患者头痛发作明显延迟(分别为16.2±6.7小时和13.2±4.3小时);P = 0.041,与未重新插入针芯的患者相比,他们的PDPH严重程度更高;P = 0.002。与PDPH显著相关的因素包括甲状腺功能减退、饮茶习惯、皮肤穿刺次数和针的重新定向、首次穿刺成功率、感觉异常的发生和与骨接触、术中低血压以及下床活动时间。
在拔除脊髓穿刺针之前重新插入针芯并未影响PDPH的发生率。重新插入针芯的女性中PDPH的发作延迟且头痛严重程度更高。