Spinal opioids and the prevention of postdural puncture headache

Martlew, R. A.

doi:10.1111/j.1365-2044.2008.05803.x

Cited by 11 publications

(12 citation statements)

References 3 publications

(1 reference statement)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with our findings, two early studies demonstrated the beneficial effect of adding an IT opioid to prevent PDPH after SA. [ 8 16 ] Johnson et al . [ 16 ] performed a retrospective analysis of parturients who received SA, and demonstrated a 50% reduction in the incidence of post-spinal headache when fentanyl was added to the local anaesthetic.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 6 7 ] In addition, Martlew conducted a 9-year prospective audit and found that spinal opioids might prevent PDPH. [ 8 ] With this background, we hypothesised that the addition of intrathecal (IT) fentanyl to local anaesthetics may reduce the incidence, severity, and/or duration of PDPH in patients undergoing CS under SA. Therefore, it can be a cost-effective alternative to the expensive pencil-point needles in case of limited resources.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

2020

View full text Add to dashboard Cite

Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively ( P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group ( P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group. Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

2020

View full text Add to dashboard Cite

show abstract

“…Eldor et al presented other reports respecting the effect of epidural morphine on headache prevention after accidental dural puncture (21,22). Nevertheless, insufficient evidence exists on the preventive effects of intrathecal diamorphine on the extent of PSPH incidence and intensity (20). The EBP is employed for PSPH prevention as well.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Ginger on Preventing Post-spinal Puncture Headache in Patients Undergoing Cesarean Section

Mashak

Hashemnejad

Kabir

et al. 2018

International Journal of Women’s Health and Reproduction Scienc

View full text Add to dashboard Cite

Objectives: Post-spinal puncture headache (PSPH) has constantly been one of the research priorities, especially in women undergoing cesarean section (C-section) and it is related to physical and psychological problems. The present study aimed to evaluate the effect of ginger on preventing PSPH in patients undergoing C-section. Materials and Methods: This clinical trial was conducted on 160 women undergoing C-section with spinal anesthesia, who were eligible to enter the study in the experimental and control groups. One ginger capsule (250 mg) was prescribed every 8 hours (TDS) to the experimental group 24 hours before the C-section. The prescription of ginger was continued half an hour after transfer to the post-partum ward until the PSPH onset. PSPH intensity was measured by using visual analog scale (VAS) pain scores at 6 timepoints (Time 1=30, Time 2=60, and Time 3=90 minutes vs. Time 4=3, Time 5 =6, and Time 6=12 hours) after C-section. No interventions were performed in the control group. The data were analyzed using the SPSS software by descriptive statistics and analytical tests were applied to determine the changes in PSPH intensity. Results: The comparison results of the mean score of PSPH intensity in the experimental and control groups indicated significant differences over time (P<0.05), except for the sixth time point (12 hours after C-section). In addition, the trend of changes at 6 timepoints based on the results of the repeated-measures test demonstrated that PSPH intensity significantly differed in the two groups over time (P<0.001). Conclusions: Based on the result, the oral prescription of ginger to women undergoing C-section under spinal anesthesia led to effective PSPH prevention at 5 time-points (30, 60, and 90 minutes, along with 3 and 6 hours). Further, the trend of the changes represented that the intensity of PSPH decreased in the experimental group over time. Therefore, ginger is suggested as a noninvasive and efficient method used for preventing PSPH.

show abstract

“…The mechanism by which epidural morphine reduces PDPH is unclear. Interestingly, there was also some promise with intrathecal diamorphine, but intrathecal morphine has not been shown to reduce PDPH …”

Section: Discussionmentioning

confidence: 99%

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Bradbury

Singh

Badder

et al. 2012

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Post-dural puncture headaches (PDPHs) present an important clinical problem. We assessed methods to decrease accidental dural punctures (ADPs) and interventions to reduce PDPH following ADP. Multiple electronic databases were searched for randomised clinical trials (RCTs) of parturients having labour epidurals, in which the studied intervention could plausibly affect ADP or PDPH, and the incidence of at least one of these was recorded. Forty RCTs (n = 11,536 epidural insertions) were included, studying combined spinal-epidurals (CSEs), loss of resistance medium, prophylactic epidural blood patches, needle bevel orientation, ultrasound-guided insertion, epidural morphine, Special Sprotte needles, acoustic-guided insertion, administration of cosyntropin, and continuous spinal analgesia. The RCTs for CSE, loss of resistance medium, and prophylactic epidural blood patches were meta-analysed. Five methods reduced PDPH: prophylactic epidural blood patch {four trials, median quality score = 2, risk difference = -0.48 [95% confidence interval (CI): -0.88 to -0.086]}, lateral positioning of the epidural needle bevel upon insertion (one trial, quality score = 1), Special Sprotte needles [one trial, quality score = 5, risk difference = -0.44 (95% CI: -0.67 to -0.21)], epidural morphine [one trial, quality score = 4, risk difference = -0.36 (95% CI -0.59 to -0.13)], and cosyntropin [one trial, quality score = 5, risk difference = -0.36 (95% CI -0.55 to -0.16)]. Several methods potentially reduce PDPH. Special Sprotte needles, epidural morphine, and cosyntropin are thus far each supported by a single, albeit good quality trial. Prophylactic blood patches are supported by three trials, but these had flawed methodology. Mostly, trials were of limited quality, and further well-conducted, large studies are needed.

show abstract

Spinal opioids and the prevention of postdural puncture headache

Cited by 11 publications

References 3 publications

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

The Effect of Ginger on Preventing Post-spinal Puncture Headache in Patients Undergoing Cesarean Section

Prevention of post‐dural puncture headache in parturients: a systematic review and meta‐analysis

Contact Info

Product

Resources

About