Background: Post-dural puncture headache (PDPH) is caused by the persistent leak of cerebrospinal fluid (CSF) from the subarachnoid space. This leakage causes a decrease in the CSF volume and pressure leading to loss of the cushioning effect normally maintained by the intracranial fluid. This results in traction on the intracranial pain-sensitive structures, causing headache. The aim of the present study was to find ways to reduce the incidence and severity of PDPH in parturients undergoing spinal anesthesia for elective cesarean section. Patients and methods: This was a randomized controlled trial study conducted at Zagazig University Hospitals during the period from February to August 2020. It included 200 parturients, planned for elective caesarean section under spinal anesthesia. All parturients were kept nil orally (8 hrs for fatty meals, 6 hrs for light meals and 2 hrs for clear fluids) before the operation. Ranitidine 50 mg I.M was given to all parturients 90 minutes before the operation. Results: The severity, duration of headache was significantly lower in the propofol group compared with the control and aminophylline groups. There was no significant difference between aminophylline and control groups. Conclusion:We can conclude that propofol reduced the severity, the duration and the associated symptoms of post-dural puncture headache compared to aminophylline in parturients undergoing spinal anesthesia for elective cesarean section.
Background: Indeed, local anesthetic infiltration of surgical wounds is a straightforward, effective, and inexpensive approach of providing excellent postoperative analgesia for a wide range of surgical operations with minimal risk of adverse consequences. Objective: The purpose of this study was to evaluate the efficacy of bupivacaine, bupivacaine combined with dexmedetomidine, or ketamine for post-operative analgesia following caesarean delivery. Subjects and Methods: A total of 90 pregnant women scheduled for elective cesarean section, were equally divided into 3 equal groups (thirty each); control (C) group: received local wound infiltration with 40 mL of 0.25% bupivacaine (20 ml bupivacaine 0.5 %-and 20-ml saline) in two divided doses; dexmedetomidine (D) group: received local wound infiltration with a volume of forty mL of 0.25% bupivacaine plus 2 ug/kg dexmedetomidine; and ketamine (K) group: Patients had volume-specific local wound infiltration with forty ml of 0.25% bupivacaine plus 2 mg/kg ketamine. Results: When compared to the other two groups, the ketamine group had a significantly longer duration before they needed analgesia (P < 0.001). Morphine consumption in the ketamine group was much lower than in the other two groups. (P < 0.001). The ketamine group had the most satisfied patients compared to the other two (P < 0.001). Conclusion:It could be concluded that adding ketamine with bupivacaine in wound infiltration has a better effect than adding dexmedetomidine as regards hemodynamics stability, the time to the first analgesic request, patients' satisfaction, and the total dose of morphine consumption during the 24 hours post operatively.
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