Relatins of needle gauge & bevel direction for postdural puncture headache / 대한마취과학회지

Postdural puncture headache (PDPH) is probably the most common complication of spinal anesthesia. The incidence of spinal headache is believed to be related to age, sex, pregnancy, size of the dural puncture needle, direction of the needle bevel, and the angle at which the needle penetrates the dura. This study were done to see the relation of sex, age, needle size (23 gauge, 25 gauge & 27 gauge needle) & bevel direction (parallel, perpendicular insertion to the longutudinal dural fiber) on the incidence, duration, severity, and location. The following results were observed: 1) The overall incidence of headache was 7.9% (49 cases). 2) The size of the needle was statistically significant assouation of PDPH. 3) Headache occured in highest frequency in patients in the second and third decades. 4) The frequency of PDPH was inversely associated with age. 5) The onset of headache was 1-2 days (68%) and duration of headache was 4-5 days (82%) in postanesthetic day. 6) The severity of headache was mild and moderate in 90% cases.

Continuous Postoperative Regional Analgesia By Nerve Sheath Block For Limb Amputation Surgery / 대한마취과학회지

A study of continuous postoperative regional analgesia by nerve sheath block for limb amputation is presented. The authors reviewed 65 patients with amputation at the level proximal to the wrist or ankle. 15 patients of which were managed with continuous postoperative regional analgesia (CPRA) by nerve sheath block. At the time of exposure of nerve trunk during amputation, a catheter was introduced directy into the transected nerve sheath through a seperated stab wound, then infuse 0.5% bupivacaine 5ml prior to wound closure and postoperatively at the rate of 2 ml/4~6 hours for 3~4 days. The results were as follows : 1) Effective amputation stump analgesia was obtained, significantly reducing the need for narcotic analgesics. 2) 46 (70%) patients experienced Phantom phenomena and 30 (46%) patients experienced Phantom pain, a less frequently in CPRA group. 3) Phantom pain was more commonly observed in patients with rnore severe preamputation pain. 4) There were no significant relationships between the occurence of Phantom pain and the age of amputee or the level of amputation. We concluded that continuous postoperative regional analgesia by nerve sheath block significantly reduced the narcotic requirements in patients with ampotation surgeries.