[ study of relationship between post dural puncture headache and hemodynamic fluctuation in patients undergoing spinal anesthesia]

ABSTRACT

Most of researchers believe that post dural puncture headache [PDPH] is resulted of excessive leakage of cerebrospinal fluid [CSF] which leads to decrease intracranial pressure [ICP] or cerebral hypotension. Hemodynamic factors can alter ICP and CSF dynamics. The aim of this study was to determine the relationship between PDPH and hemodynamic fluctuation in patients under spinal anesthesia for orthopedic surgery. This prospective observational study was performed on 95 patients, candidate for leg orthopedic surgery, under spinal anesthesia through 23-gauge Quince needle. Blood pressure and pulse rate were recorded at 0 [before anesthesia], 1, 2, 4, 8 and 16 minutes after spinal anesthesia. Total intravenous fluid intake and ephedrine consumption during operation were assessed. Incidence, duration [day] and intensity [VAS] of PDPH were determined during 5 days after spinal anesthesia. Finally, correlation of hemodynamic fluctuation, fluid intake and ephedrine consumption with incidence, duration and intensity of PDPH were analyzed using Pierson and independent sample test. Results were considered meaningful if p<0.05. The overall incidence of PDPH was 33.3%. The mean severity and duration of PDPH were 5.83 +/- 2.11 [VAS] and 3.66 +/- 1.40 [day] respectively. There was no correlation between the occurrence and intensity of PDPH and presence of hemodynamic fluctuation, fluid intake and ephedrine consumption. The results demonstrate relatively high incidence of PDPH compared with other studies, which may be due to effect of many factors that alter this incidence. Although the hemodynamic parameters variation can effect on CSF dynamics and ICP, there is no correlation between hemodynamic fluctuations and PDPH. Also, the needle size and hole shape are the potent factors for producing the PDPH