No abstract available.
Post-Dural Puncture Headache

BACKGROUND: This study was performed to discover how much needle deflection occurs during spinal or epidural block and how it can be reduced. METHODS: A styrofoam block was used to simulate the paraspinal area of the back. A line was drawn perpendicular to the edge. Using the line as a guide, the needles were advanced through the block. Quincke-type needles of 22 and 25 gauge, pencil-type needles of 22 and 25 gauge or Tuohy needles of 17 and 18 gauge were used. Using a block of 6 cm thick, spinal needle was advanced through the introducer with their apertures facing to the same or opposite direction. The deflection from the perpendicular line was measured in mm intervals. RESULTS: Small-gauged and beveled spinal needles had more deflection depending on the block thickness (P < 0.05). However, the deflection of epidural needles was not consistent. When the bevel of the introducer and spinal needle was facing the same direction, the use of an introducer needle decreased the deflection in 22 and 25 G Quicke, and 25 G Whitacre needles (P < 0.05). When facing each other, the deflection was reduced in all the spinal needles (P < 0.05), and reduced more in the 25 G Quicke needles (P < 0.05). CONCLUSIONS: Considering the estimated depth of the spinal canal, needle type, bevel direction, its gauge and the use of an introducer needle, we can take advantage of the deflection phenomenon to reduce post-dural puncture headache and to increase the success rate of a spinal or epidural block.
Needles* ; Post-Dural Puncture Headache ; Spinal Canal

BACKGROUND: Puncture of the dura can lead to a severe and often incapacitating headache. There is a report that the frequency of headache following accidental dural puncture with a 17 or 18 gauge needle is 86.7%. We reviewed the records to evaluate the efficacy of management for all patients whose epidural for postoperative pain control was complicated by dural puncture during a 3-year period. METHODS: The subject of patients in whom dural puncture occurred (35 cases in 1574 epidurals) was divided into two group. Group W5 consisted of 16 patients who received epidural saline and drugs in a rate of 5 ml/hr. Group W10 consisted of 19 patients who received epidural saline and drugs in a rate of 10 ml/hr. All patients were monitored daily by the pain control resident for occurrence of headache. RESULTS: The frequency of accidental dural puncture was 2.2% (35 cases of 1574 epidurals). In group W5, 6 of 16 patients (38%) experienced headache. In group W10, 6 of 19 patients (32%) experienced headache. There were no significant differences between both groups. CONCLUSIONS: The results of this study suggest that the epidural infusion with high volume of 0.9% saline and drugs should be considered as an alternative effective method of managing postdural puncture headache.
Headache* ; Humans ; Needles ; Pain, Postoperative ; Post-Dural Puncture Headache ; Punctures*

No abstract available.
Blood Patch, Epidural ; Child ; Humans ; Post-Dural Puncture Headache

BACKGROUND & OBJECTIVES: It is widely believed that the post-lumbar puncture headache(PLPH) is related to CSF leakage through the dural hole made by needle tract. So it is accepted that PLPH is prevented by at least 4 hour bed rest after lumbar puncture (LP). If bed rest was unneccessary, the administrative and nursing advantages would be obvious,, especially in neurologic units, whereLP has been done frequently. Therefore, we evaluate the incidence of PLPH in the ambulant and bed-rest patients prospectively and compared the incidence difference between two group. METHODS: Eighty-eight patients without preceding headache who were done lumbar puncture for diagnostic purpose were selected prospectively. We compared the incidence of PLPH between the ambulant (50 patients) and bed-rest group (38 patient,) at 6 hour and 24 hours. We also evaluated the effect of the CSF profile (count of RBC and WBC, protein level and opening pressure) on PLPH. RESULTS: The PLPH was found in 11 cases(12.5%) among bed-rest and ambulant groups. The frequency of each group was 8% (3/38) in bed-rest group and 16%(8/50) in ambulant group, but there is no significant difference between two groups (p-vaIue = 0.26). The frequency of PLPH is also not correlated to the CSF profiles; count of RBC and WBC, protein level, and opening pressure. CONCLUSIONS: There is no significant difference between the ambulant and bed rest group in the frequency of the PLPH. We conclude that the bed rest after LP is unnecessary for the prevention of the PLPH.
Bed Rest* ; Headache ; Humans ; Incidence ; Needles ; Nursing ; Post-Dural Puncture Headache* ; Prospective Studies ; Punctures ; Spinal Puncture

Postdural puncture headache is one of the well-known complications of spinal anesthesia. The sitting position is adequate for perineal and urologic operations, or when obesity makes difficult identification of midline anatomy in the lateral position. This study was done to see the effect of position (lateral or sitting position during spinal anesthesia), needle bevel direction (parallel or vertical to longitudinal dural fiber), and angle of approach (paramedian or midline) on the incidence, onset, location, severity of postdural puncture headache in the 160 patients underwent spinal anesthesia with 25-gauge Quincke needles. We observe the following results: 1) The total incidence of postdural puncture headache was 8.1%(13 cases). 2) The incidence of postdural puncture headache were 6%(lateral position), l0%(sitting position), 3%(parallel to longitudinal dural fiber), 11%(vertical to longitudinal dural fiber), 8%(paramedian approach) and 9%(midline approach). A significant increase in incidence was found with 25-gauge Quincke needles when the bevels were oriented so as to be vertical rather than parallel to the longitudinal dural fibers. 3) The onset of postdural puncture headache were within 3 days after spinal anesthesia in the almost cases (92.3%). 4) The location of postdural puncture headache were frontal(31%), occipital(15%), temporal(8%), and whole region(46%). 5) According to the duration of postdural puncture headache, two day headache was 31%, four day one was 15%, six day one was 15%, and over six day one was 38%. A significant increase in duration was found with sitting position when the bevels were oriented so as to bc vertical rather than parallel to the longitudinal dural fibers. 6) The treatments of postdural puncture headache were bed rest(20%), analgesics(54%), and epidural blood patch(31%). In conclusion, the significant increase in incidence and duration were found with 25-gauge Quincke needles when the bevels were oriented so as to be vertical rather than parallel to the longitudinal dural fibers.
Anesthesia, Spinal* ; Headache ; Humans ; Incidence ; Needles* ; Obesity ; Post-Dural Puncture Headache*

The development of postdural puncture headache is releated to patient's age, size, pregnancy, sex and type of the dural puncture needle, direction of the needle bevel. We studied the effect of needle type, 25 gauge Whitacre and 25 gauge Quincke, on the incidence of postdural puncture headache and other complications after spinal anesthesia in 300 patients. The following results were observed: 1) The incidence of postdural puncture headache is similar between 25 gauge Whitacre needle group and 25 gauge Quincke needle group(4%, respectively). 2) The onset time of headache was 10-48 hours(83%) and the duration was about 48 hours(75%) postoperatively.
Anesthesia, Spinal ; Headache* ; Humans ; Incidence ; Needles* ; Post-Dural Puncture Headache ; Pregnancy ; Punctures

PURPOSE: Postdural puncture headache is one well-known complications of spinal anesthesia. The development of postdurals puncture headaches is related to needle size, the direction of the needle bevel, the number of dural punctures and the age of the patient. However, the effect of the sitting position after spinal anesthesia (saddle block) on the incidence of postdural puncture headaches is not yet known. This study was performed to compare the incidence rates of headaches between a saddle block group (sitting position group) and a low spinal anesthesia group (supine position group). In addition, this study was performed to identify the predisposing factors influencing postdural puncture headaches (age, sex, seasonal variation, onset of headache, location of headache). METHODS: The authors analyzed 960 anal-surgery patients who were operated on using a saddle block or low spinal anesthesia at Hang Cinic from Jan. 2000 through Dec. 2000. The authors compared the incidence rates of headaches between the saddle block group (480 cases) and the low spinal anesthesia group (480 cases). RESULTS: 1) The incidence of postdural puncture headaches was not significantly different between the two groups (2.5% in the saddle block group, and 2.3% in the low spinal anesthesia group) (P>0.05). 2) The postdural puncture headache incidence rate was higher for younger patients (20~30 years) and for females. (M:F=7:16) (P<0.05). 3) The onest of postdural puncture headaches was at the postoperative 2nd day in 16 cases (70%) and at the postoperative 3rd day in 6 cases (26%). 4) The incidence rate of postdural puncture headache was higher in the summer (5 cases in June, and 3 cases in July, 4 cases in August). 5) The headache were located in the frontal region in 16 cases (70%) and in the occipital region in 3 cases (13%). CONCLUSIONS: There is no significant difference in the incidence rates of postdural puncture headaches between the saddle block group and the low spinal anesthesia group. Postdural puncture headaches had a tendency to occur more frequently in young female patients and during the summer season. In addition, a more intensive study of the use of saddle block anesthesia for ambulatory anal surgery is required.
Anesthesia ; Anesthesia, Spinal* ; Causality ; Female ; Headache ; Humans ; Incidence* ; Needles ; Post-Dural Puncture Headache* ; Punctures ; Seasons

BACKGROUND: Pencil-point needle currently are used for spinal anesthesia because of an alleged lowered incidence of postdural puncture headache. Although the direction of the side hole is one of the important factors that might affect the level and the duration of anesthesia, those data are not readily available. The aim of this study was to assess if the side hole direction of pencil-point needle during hyperbaric tetracaine injection affects the level and the duration of anesthesia. METHODS: We induced spinal anesthesia in 80 young men presenting for elective orthopedic surgery. Patients were allocated randomly with the side hole direction of the 25 gauge pencil-point needle in one of the four directions; cephalad, caudad, left lateral, right lateral. Hyperbaric 0.5% tetracaine 15~17 mg (3 to 3.4 ml) was injected with the speed of 0.75 ml/sec. Maximum sensory block level, time to maximum sensory block level, duration of sensory block (2 segments regression time) were assessed by a blinded observer with the pin-prick test and degree of motor block were measured by Bromage motor scale. Data were analysed using the Kruskal-Wallis test followed by the Mann-Whitney U test and chi-square test as appropriate (SAS v. 6.04). RESULTS: Time to maximum sensory block level was significantly fast in group 'cephalad'. Other values have no statistical differences. Post-spinal headache was observed in one case in group 'caudad'. CONCLUSIONS: Using the pencil-point needle, the time to maximum sensory block level was fast in group cephalad but there were no differences in the maximum sensory block level and the duration of sensory block among the four groups.
Anesthesia ; Anesthesia, Spinal* ; Headache ; Humans ; Incidence ; Male ; Needles* ; Orthopedics ; Post-Dural Puncture Headache ; Tetracaine*

Epidural blood patch is an effective management for treatment of severe post-dural puncture headache. Here we describe a case of a patient with hip fracture, who was complained regarded as having suspicious post-dural puncture headache after epidural anesthesia, but it failed to be treated with 4 times of epidural blood patch, and later was diagnosed with multiple metastatic brain tumor.
Anesthesia, Epidural ; Blood Patch, Epidural ; Brain Neoplasms* ; Brain* ; Headache ; Hip ; Humans ; Post-Dural Puncture Headache*