Effect of Intra-Ligamental Injection Before Removal of Spinal Needle After Spinal Anesthesia on Post Spinal Headache, no Injection Versus Normal Saline Versus Dexamethasone.
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Abstract
Background: Among the most frequent side effects of spinal anesthesia is post-dural puncture headache (PDPH), which occurs in 1-40% of scenarios. In forty percent of cases, invasive treatment options such as epidural blood patches may be necessary, and it might result in significant comorbidity. The dural healing is facilitated by fibroblastic growth; this growth is thought to be enhanced by the damage to the surrounding tissues and the presence of a blood clot. Needle trauma, normal saline and dexamethasone all can produce local irritation that might enhance fibroblastic proliferation.
Aim of the study: Assessment of intra-ligamental injection of normal saline and dexamethasone on the incidence, duration and severity of post-spinal headache following spinal anesthesia.
Patients and Methods: 75 patients were randomly selected and enrolled into this study. They were divided into three equal groups; control group (C) received nothing, group (D) received dexamethasone, and group (N) received normal saline. After performing spinal block with heavy bupivacaine, in groups D and N the needle was withdrawn for about 0.5 cm to make sure the tip of the needle is in the interspinous ligament then either 1 ml of normal saline or 1 ml of dexamethasone solution was injected before complete removal of the needle. The incidence, severity, onset, and duration of PDPH were noted at 24 hours, 72 hours, and 7 days after spinal anesthesia. The meningeal headache index was used to grade the headache's severity.
Result: The incidence of PDPH through 1 week was 4 (16%) for both dexamethasone and the control group, and 2 (8%) for the normal saline group, with non-statistically significant differences (p-value more than 0.05). Additionally, there is no statistically significant difference in headache severity. The onset of headaches was delayed in the normal saline group compared with the control group, p-value less than 0.05. Duration of headache was comparable in the three-study group with a p-value of > 0.05.
Conclusion: Both normal saline and dexamethasone are not effective in the prevention of post- dural puncture headache after spinal anesthesia.
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References
I. Munnur U, Suresh S: Backache, headache, and neurological deficit after regional anesthesia. Anesthesiol Clin North Am 2003; 21:71.
II. Morgan & Mikhail’s, Clinical Anesthesiology. Fifth edition. 2013 Page 969-970.
III. 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: 440-2.
IV. Ready LB, Cuplin S, Haschke RH, Nessly M. Spinal needle determinants of rate of transdural fluid leak. Anesth Analg 1989;69: 457-60.
V. D.K.Turnbull and D.B.Shepherd. Post-dural puncture headache:pathogenesis, prevention, and treatment. British Journal of Anaesthesia 91 (5):718-29 (2003).
VI. Azeez, S.A.S., AlMashhadani, M. and Saadoon, A. (2023) ‘The Effect of height and weight adjusted dose of intrathecal hyperbaric bupivacaine for elective caesarean section’, World Journal Of Advance Healthcare Research, 7(11), pp. 123–129.
VII. Weji, Bedilu Girma, et al."Incidence and risk factors of postdural puncture headache: prospective cohort study design." Perioperative Medicine 9 (2020):1-6.
VIII. Kassa AA, Beyen TK, Denu ZA. Post dural puncture headache (PDPH) and associated factors after spinal anesthesia among patients in University of Gondar Referral and Teaching Hospital, Gondar, North West Ethiopia; 2015.
IX. Baysinger CL, Menk EJ, Harte E, Middaugh R. The successful treatment of dural puncture headache after failed epidural blood patch. Anesth Analg 1986; 65:1242-4.
X. Morewood GH. A rational approach to the cause, prevention, and treatment of post-dural puncture headache. Can Med Assoc J 1993; 149: 1087-1094.
XI. Najafi, Atabak, et al."Is epidural dexamethasone effective in preventing post-dural puncture headache ?." Acta Anaesthesiologica Taiwanica 52.3 (2014):95-100.
XII. Reynolds F. Dural puncture and headache. Br Med J 1993; 306: 874-6.
XIII. Leibold RA, Yealy DM, Coppola M, Cantees KK. Post-dural puncture headache: characteristics, management, and prevention. Ann Emerg Med 1993; 22:1863±70.
XIV. Al-Hashel, J., Rady, A., Massoud, F. et al. Post‐dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures. BMC Neurol 22, 261 (2022).
XV. De Matteis C, Pisana G. prevention of headache from spinal anesthesia with the use of epidural cortisone. Minerva Anestesiol 1991; 57:137e40.