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At least 19 recordsLinked to original sources
PubMed1990

Post-dural puncture headache in young patients. A comparative study between the use of 0.52 mm (25-gauge) and 0.33 mm (29-gauge) spinal needles.

In a prospective study of 80 patients under 40 years of age, given spinal anaesthesia through either a 0.52 mm (25-gauge) needle or a 0.33 mm (29-gauge) needle, the incidence of post-dural puncture headache and backache was compared. There were no headaches in the 0.33 mm needle group, while in the 0.52 mm needle group an incidence of 25% was found. The incidence of backache was the same in both groups. The technique of performing spinal anaesthesia was evaluated and concluded to be slightly more difficult with a 0.33 mm needle, as estimated by the number of redirections of the needle needed to obtain cerebrospinal fluid. There were no differences between the two needles with respect to obtaining adequate spinal anaesthesia and spread of blockade.

Adult↗
PubMed1992

Post-dural puncture headache in young orthopaedic in-patients: comparison of a 0.33 mm (29-gauge) Quincke-type with a 0.7 mm (22-gauge) Whitacre spinal needle in 200 patients.

The incidence of postdural puncture headache (PDPH) following spinal anaesthesia with a 0.33 mm (29-gauge) and two types of 0.7 mm (22-gauge) Whitacre needles was investigated in 400 patients less than 40 years old. The incidence of PDPH was 2% in the 0.33 mm group, and 3.5% in the 0.7 mm group. Headache of other origin was seen in 12 patients (6%) in the 0.33 mm and in five patients (2.5%) in the 0.7 mm group. These differences were not significant. The failure rate was significantly higher in the 0.33 mm group (8.5% vs 2%) than in the 0.7 mm group (P less than 0.05). It is concluded that the 0.33 mm needle is associated with a low incidence of PDPH in young patients, but has a significantly higher failure rate than the Whitacre 0.7 mm needle, which is also a suitable choice in this age-group because of its ease of handling and the low incidence of PDPH.

Adolescent↗
PubMed1991

Incidence of post-dural puncture headache with 25-gauge Quincke spinal needle.

A retrospective study was undertaken in patients who received spinal anesthesia in past two years in order to find out the incidence of post-spinal headache. There were 3729 cases, 1997 males and 1732 females. Seventy-two patients were noted to have post-spinal headache of whom twelve were male and sixty were female. The overall incidence was 1.93%. Incidence was 0.6% and 3.5% in male and female groups respectively. With respect to the type of surgical procedures in female group, patients undergoing Cesarean section had a higher incidence than those who received other surgical procedures, being 4.8% and 1.5% respectively. In conclusion, female patients were noted to have higher incidence of post-spinal headache, particularly in patients undergoing Cesarean section.

Adolescent↗
PubMedDate not supplied

[Incidence of post-dural puncture headache using the 24G "pencil tip" needle. Prospective study in 100 young patients].

We studied the incidence of headache after dural punction using a "pencil-tip" 24G needle in 100 patients aged 15 to 55 years (mean 31.4 years) undergoing surgical interventions that allowed early physical activity. The study variables were age, sex, anesthetic agent, and previous history of headache. All patients received 1,500 ml of Ringer lactate during the peroperative period and after 48 hours the presence of headache was investigated. Headache was not observed in any case. We conclude that the pencil-tip 24G needle has been effective in the prevention of headache after dural punction particularly in young patients, who are traditionally considered to be at risk.

Adolescent↗
PubMed1990

[Post-dural puncture headache].

Post dural puncture headache is one of the major complications of spinal anaesthesia. In order to establish this diagnosis, the headache must be dependent on the position of the patient. The symptoms are probably due to leakage of cerebro-spinal fluid from the subarachnoid space to the epidural space which results in intracranial hypotension and tension of the nociceptive intracranial structures. The incidence is highest in young patients and the complication is observed more frequently in women than in men. In all age groups, the frequency and severity of the condition depend upon the calibre of the puncture needle and, for this reason, the finest possible needle should be employed. The only well proved prophylactic and curative treatment consists of establishing an epidural blood-patch. This procedure should be considered as the primary method of treatment in patients in whom post dural puncture headache contributes to prolongation of the period of convalescence.

Adolescent↗
PubMed1992

[The incidence of post spinal headache in a group of young patients].

Post-dural puncture headache (PDPH) is a significant and well-known complication of procedures that perforate the dura mater, e.g., clinical spinal anaesthesia (SpA). The exact mechanisms leading to PDPH are still not completely understood, although several factors, particularly the patient's age, modulate the incidence. In young patients (20-30 years) previous studies reported high occurrences of PDPH in 6%-16% of cases [5, 8], decreasing the value and acceptance of SpA in this patient group. This study was undertaken to reevaluate under reproducible study conditions the incidence of PDPH and other side effects due to SpA in a larger and more homogeneous patient group. METHODS. Two hundred and two male patients between 19 and 30 years of age were included in this study. The standard anaesthetic technique consisted of oral premedication (1 mg flunitrazepam), preanaesthetic intravenous hydration with at least 0.5 l Ringer's lactate, monitoring of vital signs, and a standard lumbar puncture (lateral position, L2/3 or L3/4 interspace, 25-gauge spinal needle, parallel bevel direction). Anaesthesia was achieved using 12.5 mg hyperbaric 0.5% bupivacaine. Anaesthetic level, onset, and duration (pinprick method) and intraoperative events were recorded. Patients were randomly immobilised for either 6 or 24 h postoperatively. Patients were visited on the 2nd, 4th, and 7th postoperative day to ascertain the occurrence of PDPH and further anaesthesia-related complications. RESULTS. The 202 patients studied had homogeneous demographic characteristics (Table 1). During surgery (average duration: 36 min +/- 18; 10-100 min) with satisfactory anaesthetic levels 1 patient demonstrated a high spinal block (T1). Intraoperatively, a significant decrease in blood pressure was noted in 5 patients (2.5%) and bradycardia in 24 (11.9%). Ten minutes after local anaesthetic instillation the sensory block reached an average level of T10 and had ascended to T8 after 25 minutes (start of surgery). During the three postanaesthetic visits PHPD was present in 7 cases (3.5%); 3 other patients had non-PDPH "tension" headaches (1.5%). All PDPHs occurred on the first 2 postoperative days with a maximum duration of 4 days (1 patient). Treatment consisted of bed rest, hydration, and/or oral analgesics. No patient developed any neurologic sequelae. Moderate back pain (12.4%) and urinary retention (2.5%) were the other postoperative complications. The duration of prophylactic postoperative immobilisation had no obvious impact on PDPH occurrence. Our patients' acceptance of SpA was very high; 98.5% of them would favour SpA for future surgery. DISCUSSION. In contrast to previous studies reporting a high incidence of PDPH (6%-16%) in young adults, we found, in a stringent investigation of a large number of comparable patients in a defined age group, a PDPH rate of 3.5% and a few other minor side effects together with good anaesthetic quality, intraoperative stability, and excellent patient acceptance. Although future studies are needed to further minimise SpA complications, we found SpA a safe anaesthetic technique in our well-defined patient group.

Adult↗
PubMed1991

[Prevention of headache from spinal anesthesia with the use of epidural cortisone].

The Authors have analysed the etiopathogenetic factors of the post-dural puncture headache. To prevent this complication they have experimented an original method: in 74 patients they have injected 1.5 mg of betamethasone (diluted in physiological solution) into the epidural space after the anaesthetic infusion. They conclude supporting the validity of this method of prevention and its safety.

Adolescent↗
PubMed1992

Spontaneous intracranial hypotension: report of two cases and review of the literature.

We report two patients with spontaneous intracranial hypotension. In addition to the cardinal features of a postural headache and a low CSF pressure, the patients also had subdural fluid collections demonstrated by head MRI. In both patients, radionuclide cisternography revealed a CSF leak along the spinal axis and rapid accumulation of radioisotope in the bladder. CSF leakage from spinal meningeal defects may be the most common cause of this syndrome. The headache is a consequence of the low CSF pressure producing displacement of pain-sensitive structures. Associated symptoms, including tinnitus and vertigo, and subdural fluid collections are presumably from hydrostatic changes among intracranial fluid compartments that occur at low CSF pressures. Methods of treatment are identical to those for post-dural puncture headaches. Epidural blood patches and epidural saline infusions have rapidly ameliorated the symptoms of spontaneous intracranial hypotension.

Adult↗
PubMed2026

Comparing the efficacy and safety of unilateral versus bilateral spinal anesthesia: a meta-analysis and systematic review.

BACKGROUND: Unilateral spinal anesthesia has gained increasing attention in recent years. Emerging evidence suggests that it provides comparable analgesia to conventional bilateral spinal anesthesia while reducing adverse effects, and its efficacy and safety compared to bilateral spinal anesthesia remains controversial. OBJECTIVE: This systematic review and meta-analysis aims to evaluate and compare the efficacy and safety of unilateral versus bilateral spinal anesthesia. DESIGN: Systematic reviews and meta-analysis of randomized controlled trials (RCTs). DATA SOURCES: A systematic search was conducted across PubMed, EMBASE, and Cochrane Library from inception to December 10, 2024. ELIGIBILITY CRITERIA: Included studies were randomized controlled trials involving adult patients (&#x2265;18&#x2009;years) undergoing surgery under spinal anesthesia, comparing unilateral versus bilateral spinal anesthesia for efficacy and adverse effects. Studies that focused exclusively on either unilateral or bilateral spinal anesthesia were excluded. The comparator group used the same local anesthetic as the experimental group, with no restrictions on adjuncts (e.g. fentanyl, morphine). RESULTS: Nineteen randomized controlled trials including 1191 patients met the inclusion criteria. Compared with bilateral spinal anesthesia, unilateral spinal anesthesia has a longer onset of sensory blockade (MD = 2.58, 95% CI: 0.93 to 4.22, p&#x2009;=&#x2009;0.002), a shorter duration of sensory blockade (MD&#x2009;=&#x2009;-27.83, 95% CI: -39.25 to -16.42, p&#x2009;<&#x2009;0.00001). In addition, unilateral spinal anesthesia significantly reduced the incidence of hypotension (RR = 0.40, 95% CI: 0.31 to 0.52, p&#x2009;<&#x2009;0.0001), nausea and vomiting (RR = 0.20, 95% CI: 0.07 to 0.56, p&#x2009;=&#x2009;0.002), and post-dural puncture headache (RR = 0.44, 95% CI: 0.23 to 0.81, p&#x2009;=&#x2009;0.009). No statistically significant differences were observed in bradycardia and urinary retention. Collectively, these findings support unilateral spinal anesthesia as a strategy that may enhance perioperative safety while maintaining adequate anesthetic efficacy in appropriately selected patients. CONCLUSIONS: Unilateral spinal anesthesia may offer a favorable balance between anesthetic efficacy and safety compared with bilateral spinal anesthesia, although its clinical utility may depend on surgical duration and patient characteristics.

Humans↗
PubMed1991

Influence of the lumbar interspace chosen for injection on the spread of hyperbaric 0.5% bupivacaine.

Forty patients undergoing elective Caesarean section were allocated randomly to receive hyperbaric 0.5% bupivacaine 2.5 ml at either the L2-3 (n = 20) or L4-5 (n = 20) interspace. Spinal injection was performed with a 29-gauge needle in 38 patients and a 25-gauge needle in two. The onset time to analgesia at T10 and T6 was significantly faster and the level of analgesia at 5 and 10 min after injection significantly higher after injection at L2-3. Maximum height and range of analgesia, the level of analgesia at 15 and 20 min after injection and the number of episodes of hypotension were not significantly different between the two groups. One case of post-dural puncture headache was recorded after use of a 29-gauge needle. Overall, the choice of lumbar interspace influenced the rate of onset of analgesia, but not the final dermatomal level (mean and range) of analgesia achieved.

Adolescent↗
PubMed1992

Comparison of 26- and 27-G needles for spinal anesthesia for ambulatory surgery patients.

Seven hundred thirty ambulatory surgery patients, randomly assigned to receive spinal anesthesia with a 26- or 27-G needle, were studied for the incidence of post-dural puncture headache (PDPH), postoperative back pain, and patient acceptance. The incidence of PDPH following the use of 26- and 27-G needles was 9.6% and 1.5%, respectively (P less than 0.05). The incidence of PDPH was 5.7% among men and 13.4% among women following the use of 26-G needles (P less than 0.05), whereas no difference between men and women was noted after the use of 27-G needles. Of the patients who were 40 yr of age or younger, the overall incidence of PDPH was 11.9%, with a 7.5% incidence among men and a 16.4% among women following the use of 26-G needles (P less than 0.05) and a 1.8% incidence of PDPH following the use of 27-G needles, with no statistical difference between genders. Postoperative back pain was experienced in 18.3% of the patients in the 26-G group and 20.2% in the 27-G group (difference not significant). Favorable acceptance of spinal anesthesia was reported in 89.4% of patients in the 26-G group and 98.2% in the 27-G group (P less than 0.01). Results from this study demonstrate that, in patients who received spinal anesthesia for ambulatory surgery, the use of 27-G needles resulted in a significantly lower incidence of PDPH and greater patient acceptance compared with the use of 26-G needles. The incidence of postoperative back pain was not significantly different between the two groups.

Adult↗
PubMed1992

Epidural blood patch in the HIV-positive patient. Review of clinical experience. San Diego HIV Neurobehavioral Research Center.

To characterize the natural history of autologous epidural blood patch (EBP) in human immunodeficiency virus (HIV)-seropositive patients, records from an ongoing longitudinal study of the neuropsychological manifestations of HIV infection were retrospectively reviewed. Of 252 participants (218 HIV-seropositive, 34 HIV-seronegative) who underwent at least one diagnostic lumbar puncture, 9 (7 seropositive, 2 seronegative) required EBP for post-dural puncture headache. After EBP, 6 of the seropositive subjects underwent serial neuropsychological evaluations over periods ranging from 6 to 24 months; none of these six subjects had a decline in neurocognitive performance or other adverse neurologic or infectious sequelae. We were unable to identify morbidity attributable to EBP in the HIV-seropositive patient followed for as long as 2 yr.

Adult↗
PubMed1992

A comparison of intrathecal, epidural, and intravenous sufentanil for labor analgesia.

A number of recent studies have suggested that the analgesic effects of highly lipid-soluble opioids are similar when these agents are administered either epidurally or intravenously. We sought to test whether the lipid-soluble opioid sufentanil was more effective when administered intrathecally than when administered epidurally or intravenously. Twenty-four women during active labor received sufentanil 10 micrograms either intrathecally (n = 9), epidurally (n = 8), or intravenously (n = 7), using a combined spinal-epidural technique. The sufentanil was administered alone, without concomitant local anesthetics. Analgesia was assessed using the visual analogue score as well as the time elapsed from the administration of study drug to the patient's request for additional analgesia via the epidural catheter (bupivacaine 0.25%). The median duration of analgesia (median, interquartile range) was 84 (70-92) min in the intrathecal group, 30 (23-32) min in the epidural group, and 34 (17-30) min in the intravenous group (P < 0.001). The intrathecal group showed rapid and significant decrease in visual analogue scale scores, whereas visual analogue scale scores in the other two groups did not decrease and remained significantly elevated compared to those of the intrathecal group at all observation points. Side effects were limited to pruritus in 3 patients (2 moderate and 1 severe) in the intrathecal group. No patient developed post-dural puncture headache. We conclude that sufentanil 10 micrograms intrathecally provides rapid and effective analgesia of 1-2-h duration during labor. Epidural and intravenous use of this dose of sufentanil did not provide evidence of satisfactory analgesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Adverse effects of spinal and epidural anaesthesia.

Spinal and epidural blockade are similar in many respects in the anaesthesia they produce, since they both cause major conduction blockade with local anaesthetic agents. Physiologically, the blockade involves the production of a sympathectomy with venous pooling and decreased venous return, causing decreased cardiac output and hypotension. Physiological complications include bradycardia, heart block and, rarely, cardiac arrest. Nonphysiological complications include high or total block from extensive spread of the local anaesthetic agent, and toxic reactions from inadvertent intravenous injection of local anaesthetic during epidural administration. Neurological complications include paraplegia from either haematoma or abscess, arachnoiditis or trauma. Post-dural puncture headache is a persistent problem that is more pronounced in younger patients. Cranial nerve lesions are rarely seen with spinal anaesthesia. This review covers the adverse effects of spinal and epidural blockade and what can be done to prevent and/or treat them. With attention to proper performance and patient selection, spinal and epidural anaesthesia are safe and efficacious options when choosing anaesthetic technique.

Anesthesia, Epidural↗
PubMed1991

[Continuous spinal anesthesia versus continuous epidural anesthesia in surgery of the lower extremities. A prospective randomized study].

Continuous epidural anesthesia (CEA) is generally accepted as a routine method of regional anesthesia while there has been only limited application of continuous spinal anesthesia (CSA), due mainly to a lack of adequate spinal catheters. With the introduction of a new, ultra-thin spinal catheter (32 G) inserted via a thin puncture needle, some of the complications reported after CSA can be eliminated. We studied CSA versus CEA in lower-extremity operations. METHODS. We evaluated 33 patients in a prospective, randomized study. All were comparable with respect to age, anesthetic risk (ASA II-III), and pre-existing diseases. The only exclusion criterium was the presence of a coagulation disturbance. The CSA group consisted of 17 patients (mean age 75.5 +/- 0.1 year); 26 G puncture needle and 32 G catheter were used. The CEA group consisted of 16 patients (mean age 73.8 +/- 11.0 years); an 18 G puncture needle and 22 G epidural catheter with a stylet were inserted with the loss-of-resistance technique. Both catheters were placed with the patient in a sitting position and left in place for 24 h in order to administer local anesthetics (LA) for postoperative analgesia as required. Hemodynamic parameters-mean arterial pressure (MAP) and heart rate (HR)-were compared in each group at 5-min intervals for 30 min after administration of local anesthetic and at 10-min intervals during the operation. Additionally, the ECG, pulse oximetry, respiratory rate, diuresis, and blood gases were monitored. After placement of the catheter, patients in the CSA group received 1.9 ml (+/- 0.2) bupivacaine HCl 0.5%. Patients in the CEA group received 12.6 ml (+/- 2.5) bupivacaine HCl 0.5%. For statistical evaluation of the data we used mean values, standard deviation (+/-), the Kruscal-Wallis procedure, and Student's t-test for unpaired data. P less than 0.05 was considered significant. RESULTS. The mAPs in the CSA group generally remained lower than those of the CEA group. However, over the course of the operation as well as after repeated injections, the difference between the two groups decreased. Only at 5 min after administration of the initial dose was a statistically significant difference in blood pressures between the two groups observed. A clinically relevant, rapid decrease in blood pressure due to relatively high doses of LA was seen in 1 case in each group. The first reinjection of LA after the initial dose was after 1.9 h in the CSA group (bupivacaine HCl 0.5% 1 +/- 0.3 ml) and after 1.8 h in the CEA group (bupivacaine HCl 0.5% 4.5 +/- 1 ml). The total dose of bupivacaine in the CSA group was 0.18 ml/kg per hour versus 0.8 ml/kg in the CEA group. No post-dural puncture headache was observed in the CSA group. DISCUSSION. The catheter designed for CSA is easy to use, although because of its small diameter a certain manual dexterity is required. In addition, CSA resulted in a more rapid onset of action and more pronounced sensorimotor blockade than did CEA. Hemodynamic alterations and side effects were comparably low in both groups.

Aged↗