Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942013000200005
Brazilian Journal of Anesthesiology
Scientific Article

A reinserção do estilete não afeta a incidência de cefaleia pós-punção dural (CPPD) após raquianestesia

Reinsertion of the stylet does not affect incidence of post dural puncture headaches (PDPH) after spinal anesthesia

Nadir S. Sinikoglu; Hacer Yeter; Funda Gumus; Enver Belli; Aysin Alagol; Nesrin Turan

http://dx.doi.org/10.1590/S0034-70942013000200005 Braz J Anesthesiol, vol.63, n2, p.188-192, 2013
PDF Português
PDF English
Downloads: 0
Views: 964

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.

Palavras-chave

ANESTESIA, Regional, raquianestesia, Cefaléia Pós-Punção Dural

Abstract

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.

Keywords

Anesthesia, Spinal, Post-Dural Puncture Headache

References

Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91:718-729.

Tohmo H, Vuorinen E, Muuronen A. Prolonged impairment in activities of daily living due to postdural headache after diagnostic lumbar puncture. Anaesthesia. 1998;53:299-307.

Lybecker H, Djernes M, Schmidt JF. Postdural puncture headache (PDPH): onset, duration, severity, and associated symptoms. An analysis of 75 consecutive patients with PDPH. Acta Anaesthesiol Scand. 1995;39:605-612.

Seeberger MD, Kaufmann M, Staender S, Schneider M, Scheidegger D. Repeated dural punctures increase the incidence of postdural puncture headache. Anesth Analg. 1996;82:302-305.

Pittoni G, Toffoletto F, Calcarella G, Zanette G, Giron GP. Spinal anesthesia in outpatient knee surgery: 22-gauge versus 25-gauge Sprotte needle. Anesth Analg. 1995;81:73-79.

Strupp M, Brandt T, Müller A. Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients. J Neurol. 1998;245:589-592.

Bayhi D, Cork RC, Heaton JF, Nolan TE. Prospective survey of continuous versus single-injection spinal anesthesia in obstetrics. South Med J. 1995;88:1043-1048.

Evans RW, Armon C, Frohman EM, Goodin DS. Assessment: prevention of post-lumbar puncture headaches: report of the therapeutics and technology assessment subcommittee of the American Academy of Neurology. Neurology. 2000;55:909-914.

Richman JM, Joe EM, Cohen SR, Rowlingson AJ, Michaels RK, Jeffries MA. Bevel direction and postdural headache. Neurologist. 2006;12:224-228.

Bromage PR. A comparison of the hydrochloride and carbon dioxide salt of lidocaine and prilocaine in epidural analgesia. Acta Anaesth Scand. 1965;17(^sSuppl):55-69.

The International Classification of Headache Disorders. 2004;24:9-160.

Lavi R, Rowe JM, Avivi I. Lumbar puncture: it is time to change the needle. Eur Neurol. 2010;64:108-113.

Vilming ST, Kloster R, Sandvik L. The importance of sex, age, needle size, height, and body mass index in post-lumbar puncture headache. Cephalalgia. 2001;21:738-743.

Bezov D, Lipton RB, Ashina S. Post-dural puncture headache: Part I: Diagnosis, epidemiology, etiology, and pathophysiology. Headache. 2010;50:1144-1152.

Raymond JR, Raymond PA. Post-lumbar puncture headache: Etiology and management. West J Med. 1989;148:551-554.

Lomax S, Qureshi A. Unusually early onset of post-dural puncture headache after spinal anaesthesia using a 27G Whittacre needle. Br J Anaesth. 2008;100:707-708.

Bezov D, Ashina S, Lipton R. Post-dural puncture headache: Part II - Prevention, management, and prognosis. Headache. 2010;50:1482-1498.

Serpell MG, Rawal N. Headaches after diagnostic dural punctures. BMJ. 2000;321:973-974.

Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry. 1991;54:440-442.

Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. 2006;82:713-716.

Buettner J, Wresch KP, Klose R. Postdural puncture headache: comparison of 25-gauge Whitacre and Quincke needles. Reg Anesth. 1993;18:166-169.

Devcic A, Sprung J, Patel S, Kettler R, Maitra-D'Cruze A. PLPH in obstetric anesthesia: comparison of 24-gauge Sprotte and 25gauge Quincke needles and effect of subarachnoid administration of fentanyl. Reg Anesth. 1993;18:222-225.

Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: a randomized comparison of five spinal needles in obstetric patients. Anesth Analg. 2000;91:916-920.

Schmittner MD, Terboven T, Dluzak M, Janke A, Limmer ME, Weiss C. High incidence of post-dural puncture headache in patients with spinal saddle block induced with Quincke needles for anorectal surgery: a randomised clinical trial. Int J Colorectal Dis. 2010;25:775-781.

MacArthur C, Lewis M, Knox EG. Accidental dural puncture in obstetric patients and long term symptoms. BMJ. 1993;306:883-885.

Lybecker H, Moller JT, May O, Nielsen HK. Incidence and prediction of postdural puncture headache: a prospective study of 1021 spinal anesthesias. Anesth Analg. 1990;70:389-394.

Deibel M, Jones J, Brown M. Best evidence topic report: reinsertion of the stylet before needle removal in diagnostic lumbar puncture. Emerg Med J. 2005;22.

5dd42bae0e88256a2bc63493 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections