Bevel Direction and Postdural Puncture Headache

Richman, Jeffrey M.; Joe, Emily M.; Cohen, Seth R.; Rowlingson, Andrew J.; Michaels, Robert K.; Jeffries, Maggie A.; Wu, Christopher L.

doi:10.1097/01.nrl.0000219638.81115.c4

Cited by 93 publications

(47 citation statements)

References 39 publications

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“…The overall postdural puncture headache in this study was 42.6% which is comparable to Egypt study [10], but excessively higher than other studies report [9,11,12]. The high percentage of prevalence of PDPH in this study might be related with the most 77.8 % of participants were received spinal anesthesias using big spinal needle.…”

Section: Discussionsupporting

confidence: 61%

Assessment of the Prevalence and Associated Risk Factors of Post Dural Puncture Headache (PDPH) after Cesarean Section Delivery under Spinal Anesthesia

Tarekegn¹,

Eshetie²,

Aregawi³

et al. 2017

JACCOA

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Background: Post-Dural Puncture Headache (PDPH) is a common problem after a deliberate puncture of the dura-arachnoid for the purposes of diagnosis, therapy, spinal anesthesia, or unintentionally during epidural procedures. It is a clinically main complication which affects the daily life of patients with marked restriction of their physical activities. Spinal anesthesia is the frequent anesthetic procedure for obstetric patients which identified as cause for PDPH. The aim of the study was to assess the prevalence and associated risk factors of PDPH after Cesarean Section (CS) delivery under spinal anesthesia.Method:An institution based cross sectional study design was conducted on all eligible obstetric patients who came for operation under spinal anesthesia from September, 2015 to January,2016. The data collection method was including chart review and patient follow up for three days of post operative period.Results: 107/251 (42.6 %) patients developed PDPH. Among those patiens with PDPH big needle sizes (AOR=8.6; 95% CI: 0.06-0.46) and repeated number of attempts (AOR= 4.54; 95% CI: 0.52 -39.14), were found to be significantly associated with the dependent variable of PDPH on the multi variate logistic regression. Conclusion and recommendation:In this study, we showed the prevalence of PDPH was higher, 107/251 (42.6 %) compared with other literatures. The study also showed that big spinal needles and repeated number of attempts were the independent associated risk factors for PDPH in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia. The higher magnitude of PDPH has to be reduced by avoiding use of big needles, and the repeated dura puncture.

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Section: Discussionsupporting

confidence: 61%

Assessment of the Prevalence and Associated Risk Factors of Post Dural Puncture Headache (PDPH) after Cesarean Section Delivery under Spinal Anesthesia

Tarekegn¹,

Eshetie²,

Aregawi³

et al. 2017

JACCOA

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“…Compared with opioid analgesia, CPNB (regardless of catheter location) provides better postoperative analgesia and leads to reductions in opioid use as well as the incidence of nausea, vomiting, pruritus and sedation (Richman et al, 2006 Level I).…”

Section: Continuous Peripheral Nerve Blockadementioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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“…The direction of the needle bevel during insertion also contributes to the occurrence of PDPH. If the bevel of the spinal needle is inserted perpendicular to the fibres of the Dura (which are believed to run longitudinally) an increased incidence of PDPH is expected [1,2,[4][5][6]13,14].…”

Section: Introductionmentioning

confidence: 99%

Post Dural Puncture Headache (PDPH) and Associated Factors after Spinal Anesthesia among Patients in University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia

Kassa¹,

Beyen²,

Denu³

2015

J Anesth Clin Res

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Background: Post dural puncture headache (PDPH) has been a problem for patients after dural puncture. It is one of the most frequently occurring complications following spinal anesthesia (SA). It is believed to originate from persistent leakage of cerebrospinal fluid (CSF) through the punctured Dura, greater than the CSF production after lumbar puncture. Although the problem has been widely reported, its magnitude and associated factors has never been studied in our country. Thus, the aim of this study is to assess the magnitude of post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in university of Gondar referral and teaching hospital.

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Bevel Direction and Postdural Puncture Headache

Abstract: Our meta-analysis indicates that with use of a cutting needle, insertion in a parallel/longitudinal fashion may significantly reduce the incidence of PDPH, although the reasons for this decrease are unclear.

Cited by 93 publications

References 39 publications

Assessment of the Prevalence and Associated Risk Factors of Post Dural Puncture Headache (PDPH) after Cesarean Section Delivery under Spinal Anesthesia

Assessment of the Prevalence and Associated Risk Factors of Post Dural Puncture Headache (PDPH) after Cesarean Section Delivery under Spinal Anesthesia

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Post Dural Puncture Headache (PDPH) and Associated Factors after Spinal Anesthesia among Patients in University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia

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