RESUMO
The aim was to compare visibility of the spinal space in sitting and lateral positions, number of attempts, spinal needle depth, skin-dura mater distance and the possible complications; in application of spinal anesthesia, using ultrasound in pregnant patients scheduled to receive elective cesarean operations. The study was conducted prospective-randomly after receiving approval from the ethics committee and the patients' permission. ASA I-II 50 pregnant patients were divided into two groups. The patients in Group SP were those placed in a sitting position and the patients in Group LP were those placed in a lateral position. In both groups, the skin-dura mater distance was recorded through an out-of plane technique accompanied by ultrasound. The depth of the spinal needle was measured. The number of attempts, the level of attempts recorded. The degree of visibility of the vertebral space was observed through ultrasound and was numerically scored. Intraoperative and postoperative complications were recorded. There was no difference between the number of attempts, Modified Bromage Scale and mean measurements of skin-dura mater distance observed through ultrasound. The mean needle depths of Group LP were statistically found significantly higher than Group SP [p=0.002]. Our study supports the notion that access to the skin-dura mater distance is longer in the lateral decubitus position when skin-dura mater distance is evaluated by measuring needle depth
RESUMO
JUSTIFICATIVA E OBJETIVOS: Este estudo foi conduzido para investigar os efeitos da reinserção do estilete em cefaleia pós-punção dural (CPPD) após raquianestesia. MÉTODOS: Foram selecionados para este estudo 630 pacientes submetidos a cirurgia eletiva com raquianestesia. Os pacientes foram randomicamente designados para dois grupos: Grupo A (reinserção do estilete antes da retirada da agulha) e Grupo B (retirada da agulha sem reinserção do estilete). Os pacientes foram observados durante 24 horas no hospital e avaliados quanto à CPPD no terceiro e sétimo dias do estudo. RESULTADOS: No geral, a incidência da CPPD foi de 10,8% (68 pacientes). Trinta e três desses pacientes (10,5%) que estavam no Grupo A e 35 (11,1%) no grupo B tiveram CPPD. Não houve diferença significativa entre os dois grupos em relação à CPPD. CONCLUSÕES: Ao contrário da punção lombar diagnóstica, a reinserção do estilete após raquianestesia com agulhas tipo Quincke de calibre 25 não reduz a incidência de CPPD.
BACKGROUND AND OBJECTIVES: This study was conducted to investigate the effects of reinsertion of the stylet after a spinal anesthesia procedure on the Post Dural Puncture Headache (PDPH). METHODS: We have enrolled into this study 630 patients who were undergoing elective operations with spinal anesthesia and randomized them to Group A (stylet replacement before needle removal) and Group B (needle removal without stylet replacement). These patients were observed for the duration of 24 hours in the hospital and they were checked for PDPH on the 3rd and the 7th day of the study. RESULTS: Overall, the PDPH incidence was at 10.8% (68 patients). Thirty-three of these patients (10.5%) who were in Group A (stylet replacement before needle removal) and the other 35 patients (11.1%) who were in Group B (needle removal without stylet replacement) experienced PDPH. There was no significant difference between the two groups with respect to the PDPH. CONCLUSIONS: In contrary to the diagnostic lumbar puncture, reinsertion of the stylet after spinal anesthesia with 25-gauge Quincke needles does not reduce the incidence of PDPH.
JUSTIFICATIVA Y OBJETIVOS: Este estudio fue hecho para investigar los efectos de la reinserción del estilete en la cefalea pos punción dural (CPPD) después de la raquianestesia. MÉTODOS: Un total de 639 pacientes sometidos a la cirugía electiva con raquianestesia se seleccionaron para este estudio. Los pacientes fueron aleatoriamente designados para dos grupos: Grupo A (reinserción del estilete antes de la retirada de la aguja) y Grupo B (retirada de la aguja sin la reinserción del estilete). Los pacientes fueron observados durante 24 horas en el hospital y evaluados CPPD en el tercero y en el séptimo día del estudio. RESULTADOS: En general, la incidencia de CPPD fue de un 10,8% (68 pacientes). Treinta y tres de ellos (10,5%) que estaban en el Grupo A (reinserción del estilete antes de la retirada de la aguja) y 35 (11,1%) en el grupo B (retirada de la aguja sin la reinserción del estilete) tuvieron CPPD. No hubo diferencia significativa entre los dos grupos con relación a la CPPD. CONCLUSIONES: Al contrario de la punción lumbar diagnóstica, la reinserción del estilete posterior a la raquianestesia con agujas tipo Quincke de calibre 25 no reduce la incidencia de CPPD.