Decreased incidence of headache after unintentional dural puncture in patients with cesarean delivery administered with postoperative epidural analgesia |
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Authors: | Mehmet Cesur Haci A Alici Ali F Erdem Fikret Silbir Mine Celik |
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Institution: | (1) Department of Anesthesiology and Reanimation, Ataturk University, Medical Faculty, Erzurum, Turkey;(2) Yunus Emre Mah. Tomurcuk Sok., İkizler Apt. B Blok No: 7/7, 25080 Yenisehir/Erzurum, Turkey |
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Abstract: | Purpose To investigate how subsequent placement of a catheter into the epidural space after unintentional dural puncture for postoperative
analgesia for 36–72 h affected the incidence of post-dural puncture headache (PDPH).
Methods The records of 52 parturients who had had accidental dural puncture in cesarean delivery were reviewed. The parturients were
assigned to two groups. Twenty-eight parturients were assigned to the study group, in whom an epidural catheter was inserted
and was used for anesthesia and postoperative analgesia. Twenty-four parturients were assigned to the control group, in whom
spinal anesthesia (n = 20) or general anesthesia (n = 4) was applied. For postoperative analgesia in patients with incision pain above visual analog scale (VAS) 3, 3 mg morphine
in 15 ml saline was administered through the epidural catheter in the study group, while intramuscular meperidine or tramadol
was administered in the control group. Once PDPH was observed, conservative treatment was tried first. If the headache persisted
despite conservative treatment, an epidural blood patch was applied through the catheter or a reinserted epidural needle.
Results The study group demonstrated significant reduction of the incidence of PDPH and reduction in the indication for an epidural
blood patch compared to the control group (7.1% vs 58% P = 0.000] and 3.6% vs 37.5% P = 0.002], respectively).
Conclusion Subsequent catheter placement into the epidural space after unintentional dural puncture in cesarean delivery and leaving
the catheter for postoperative analgesia for 36–72 h may reduce the incidence of PDPH. |
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Keywords: | Cesarean delivery Post-dural puncture headache Epidural blood patch Morphine |
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