ABSTRACT
Objective: Post dural puncture headache [PDPH] is one of major complications of spinal anesthesia. There are two approaches to administer spinal anesthesia i.e. median and paramedian. We conducted this study to compare the frequency of PDPH after spinal anesthesia for cesarean section with median versus paramedian approach using 25 gauge pencil point needle
Methodology: This randomized controlled trial was conducted at Departments of Anesthesiology, Surgical Intensive Care and Pain Management Centre as well as Gynecology and Obstetrics, Peoples University of Medical and Health Sciences, Nawabshah, Benazirabad [Pakistan]. One hundred and twenty females underwent elective cesarean section under spinal anesthesia were enrolled. After informed written consent, the parturients were randomly divided into two equal groups by lottery method; Group A patients received spinal block with median approach and Group B patients received it with paramedian approach. All spinal blocks were performed with 25 gauge pencil point needle. The patients were asked about the presence or absence of headache through Visual Analogue Scale [VAS] in the next 72 hours
Results: In median approach [Group A], 3 patients [5%] had PDPH; whereas in paramediannapproach [Group B] only 1 patient [1.6%] had PDPH. All the patients were of younger age and low parity. They developed PDPH within 24 -48 hours which was of mild to moderate in degree on VAS and relieved by rest, plenty of fluids and simple analgesics containing caffiene in mild case. While strong analgesics and muscle relaxants were added in cases of moderate PDPH. PDPH was relieved within 2-3 days in all cases without any complication. The difference was statistically insignificant [p-value=0.30]
Conclusion: Paramedian approach is better than median approach in terms of reduction in the frequency of PDPH, though the results were statistically insignificant?
ABSTRACT
Objective: To compare the effects of general and spinal anesthesia in patients undergoing elective Cesarean section in terms of neonatal outcome.
Study design: Randomized control trial
Setting: This study was conducted in the department of anesthesiology, surgical intensive care and pain management and department of Gynecology and Obstetrics, Peoples Medical College Hospital Nawabshah
Duration of study: June 2009 to December 2009
Subjects and methods: Patients in this study were admitted through obstetric OPD for lower segment Cesarean section. Patients were selected by simple random envelop draw method. Sample size were 160 patients, they divided in to two equal groups. Group A [N=80] patients underwent spinal anesthesia and Group B patients underwent general anesthesia. Immediately after delivery of the neonate, umbilical artery blood sample was taken for assessment of blood pH. Apgar score was assessed at 01 and 05 minutes and recorded on proforma. Anesthesia was labeled as effective i-e satisfactory if the Apgar score was 7 and above and blood pH 7.2 and above
Results: An Apgar score >7 was observed at 01 and 05 minutes in 78[97.5%] and 80 [100%] neonates respectively in group A while it was 60[75%] and 74 [92.5%] in group B neonates. Apgar score>7 was observed in signi cantly more neonates in group A as compare to group B [p =0.028]. Average Apgar score at 01 and 05 minutes was also signi cantly higher in group A than group B; 8.04+/-0.82 vs 7.10+/-0.92 [p=0.0001] and 9.89+/-0.32 vs 9.34+/-1.07 respectively [p=0.0001].Umbilical artery blood pH>7.2 was observed signi cantly high in group A93.8% as compared to group B 83.8% [p=0.045]. Also average pH was signi cantly high in group A than group B e.g. 7.38+/-0.15 vs 7.21+/-0.16 [p=0.017]
Conclusion: Spinal anesthesia is associated with better neonatal out come as compared to general anesthesia in elective Cesarean sections