scholarly journals Restrictive versus liberal perioperative fluid strategies to prevent post-dural puncture headache after cesarean delivery

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
M. Elsonbaty ◽  
Nora A. Agiza ◽  
Tarek Abdelbarr ◽  
Heba Salah
Keyword(s):  
Cesarean Delivery ◽  
Fluid Therapy ◽  
Dural Puncture ◽  
Controlled Trial ◽  
Spinal Block ◽  
Post Dural Puncture Headache ◽  
Oral Fluids ◽  
Liberal Group ◽  
Headache Pain ◽  
Spinal Hypotension

Abstract Background Post-dural puncture headache is a common complication after cesarean delivery. The role of fluid therapy in prevention of post-dural puncture headache is not clear. The aim of this work is to compare restrictive versus liberal perioperative fluid protocols in prevention of post-dural puncture headache. A randomized controlled trial was conducted including 100 full-term pregnant women undergoing cesarean delivery under spinal block. After receiving spinal block, all patients received 1.5 mcg/kg phenylephrine and crystalloid co-load at a rate of 10 mL/h. Patients were assigned into either restrictive group (did not receive fluid preload + received postoperative crystalloid therapy at a rate of 2 mL/kg/h till resuming oral fluids) or liberal group (received crystalloid preload 5 mL/kg before spinal block + received postoperative crystalloids at a rate of 6 mL/kg/h till resuming oral fluids. Both groups were compared according to the incidence of post-dural puncture headache, pain scores, systolic blood pressure, heart rate, incidence of post-spinal hypotension, nausea, and vomiting. Results The incidence of post-dural puncture headache was lower in the restrictive group compared to the liberal group {10(20%) vs 22(44%), P = 0.018}. All other secondary outcomes were comparable between both groups. Conclusion Restrictive fluid therapy was associated with lower incidence of PDPH after cesarean delivery without impacting patient hemodynamic profile.

scholarly journals Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yasmin S. Hassabelnaby ◽  
Ahmed M. Hasanin ◽  
Nada Adly ◽  
Maha M. A. Mostafa ◽  
Sherin Refaat ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cesarean Delivery ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Spinal Hypotension

scholarly journals Suboccipital Muscles Injection for Management of Post-Dural Puncture Headache After Cesarean Delivery: A Randomized-Controlled Trial

2019 ◽  
Vol 7 (4) ◽  
pp. 549-552 ◽  
Author(s):  
Mhamed Abdelraouf ◽  
Maged Salah ◽  
Mohsen Waheb ◽  
Ahmed Elshall
Keyword(s):  
Cesarean Section ◽  
Dural Puncture ◽  
Controlled Trial ◽  
Demographic Data ◽  
Visual Analogue Score ◽  
Control Group ◽  
Neck Muscle ◽  
Rescue Analgesia ◽  
Post Dural Puncture Headache ◽  
Control Group Group

INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay. AIM: This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section. PATIENT AND METHODS: A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). All patients received bilateral intramuscular (in the suboccipital muscle) (Group S) (n = 45) patients received lidocaine 40 mg (2 mL of 2% solution) and dexamethasone 8mg in a total volume of 4 mL; whilst, patients in the control group (group C) (n = 45) received 4 mL normal saline. The primary outcome is the Visual Analogue Score for a headache at 24 hours after injection. RESULTS: Demographic data and the baseline, headache score, neck muscle spasm, and nausea were comparable in both groups. Group S showed lower headache score compared to group C at all the post-injection time points. All patients in group S showed resolution of nausea after the intervention; while none of the control group showed any improvement. All patients of group C needed rescue analgesia; while only 6 (13.3%) patients in group S asked for an analgesic. Time to the first analgesic request was longer in group S compared to group C (10.17 ± 7.96 hours versus 1.00 ± 0.00 hours, P < 0.001). CONCLUSION: Ultrasound-guided injection of the dexamethasone-lidocaine mixture in suboccipital muscles is effective management of PDPH after CS.

scholarly journals Punção Acidental da Dura e Cefaleia Pós-punção da Dura na População Obstétrica: Oito Anos de Experiência

2016 ◽  
Vol 29 (4) ◽  
pp. 268
Author(s):  
Maria Vaz Antunes ◽  
Adriano Moreira ◽  
Catarina Sampaio ◽  
Aida Faria
Keyword(s):  
Conservative Treatment ◽  
Epidural Catheter ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Spinal Block ◽  
Post Dural Puncture Headache ◽  
Retrospective Audit ◽  
Prophylactic Measures ◽  
Blood Patch ◽  
Accidental Dural Puncture

<p><strong>Introduction:</strong> Accidental dural puncture is an important complication of regional anesthesia and post-dural puncture headache remains a disable outcome in obstetric population. The aim of our study was to calculate the incidence of accidental puncture and post-puncture headache and evaluate its management among obstetric anesthesiologists.<br /><strong>Material and Methods:</strong> We conducted a retrospective audit, between January 2007 and December 2014. We reviewed the record sheets of patients who experienced either accidental puncture or post-puncture headache. We excluded the patients undergoing spinal block. We use the SPSS 22.0 for statistical analyses.<br /><strong>Results:</strong> We obtained 18497 neuro-axial blocks and 58 accidental dural punctures (0.3%). After detected puncture, in 71.4% epidural catheter was re-positioned and 21.4% had intra-thecal catheters. Forty-five (77.6%) developed headache and the prophylactic measures were established in 76.1%. Conservative treatment was performed in all patients. The epidural blood patch was performed in 32.8% with a 84.2% of success.<br /><strong>Discussion:</strong> The incidence of post-dural puncture headache is unrelated to the type of delivery or insertion of intrathecal catheter. The re-placement of the epidural catheter remains the main approach after puncture. The institution of prophylactic measures is a common practice, despite the low level of evidence. We performed epidural blood patch after failure of conservative treatment.<br /><strong>Conclusion:</strong> The incidence of accidental dural puncture and post-dural puncture headache was similar to the literature. Despite being a common complication, there remains lack of consensus on its approach.</p>

scholarly journals Post Dural Puncture Headache in Fibromyalgia after Cesarean Section: A Comparative Cohort Study

2016 ◽  
Vol 6;19 (6;7) ◽  
pp. E871-E876
Author(s):  
Khalid M. Morsy
Keyword(s):  
Chronic Pain ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Dural Puncture ◽  
Control Group ◽  
Elective Cesarean Delivery ◽  
Post Dural Puncture Headache ◽  
Elective Cesarean ◽  
Control Study

Background: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they have enhanced central nervous system sensitization and decreased descending inhibition. Objective: The current study aims to verify the incidence and chronicity of PDPH in FMS patients. Study Design: Case control study. Methods: In a comparative control study, 70 fibromyalgia patients were scheduled for an elective cesarean delivery fibromyalgia group or Group 1. Group 2 included 70 women scheduled for elective cesarean delivery who had no history of chronic pain and is used as a control group. Both groups were compared regarding the incidence of development of PDPH in the first postoperative 48 hours and the persistence of PDPH for 7 days or more. Settings: Women’s Health Hospital, Assiut University, antenatal Clinic. Results: The fibromyalgia group reported more PDPH (18 patients, 25.7%) as compared to the control group (10 patients, 14.3%), P < 0.01. PDPH persisted for 7 or more days in 8 patients in the fibromyalgia group (11.4%) while, it persisted in 2.86% of the control patients. PDPH continued for more than 3 months in 2 patients in the fibromyalgia group (2.86%) Limitations: Difficulty in calculating the dose of analgesics as patients with fibromyalgia may use other analgesics due to musculoskeletal pain. Conclusion: Dural puncture increases the incidence of PDPH in fibromyalgia patients in comparison with normal controls without increasing other postoperative side effects. Key Words: Fibromyalgia, cesarean section, post dural puncture headache, spinal anesthesia

scholarly journals Ondansetron Is an Effective Alternative to Decrease the Incidence of Postspinal Hypotension in Healthy Subjects Undergoing Infra-Umbilical Surgeries Compared To Combined Volume Loading and Vasoconstrictors: Randomized Controlled Trial

2018 ◽  
Vol 6 (12) ◽  
pp. 2363-2368
Author(s):  
Sherif Abdallah Mohamed ◽  
Ayman Mohamed Hussam ◽  
Sarah Ahmed Abdallah ◽  
Khaled Abdelfattah Sarhan ◽  
Abdelkhalek Mahmoud Shaban
Keyword(s):  
Heart Rate ◽  
Spinal Anaesthesia ◽  
Controlled Trial ◽  
Nausea And Vomiting ◽  
Combination Group ◽  
Spinal Block ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Spinal Hypotension

BACKGROUND: One of the important and predicted physiological effects of spinal anaesthesia is hypotension. A range of strategies including mechanical interventions, intravenous fluids and vasoconstrictor drugs have been used to minimise or prevent spinal anaesthesia-induced hypotension. Observational studies suggest that ondansetron reduces the incidence of post-spinal hypotension (PSH) and support the use of combined fluid preloading and vasoconstrictors for this purpose (but with limited doses) to avoid side effects as fluid overload and tachycardia respectively. AIM: As no RCT had ever compared the use of Ondansetron alone with combined vasoconstrictors and fluid preload, so, this randomised controlled trial has evaluated the efficacy of the use of ondansetron alone compared to the combined use of fluid preload and vasoconstrictors to decrease the incidence of spinal hypotension. METHODS: Ninety patients of ASA grade I between the age of 18 and 45 years scheduled to undergo elective surgical procedures on the lower extremity or lower abdomen under spinal anaesthesia were included in the study. The patients were randomly allocated into two groups of 45 each. Group I patients (ondansetron group) received 4 mg ondansetron in 5 ml normal saline (IV) 15 minutes before induction of spinal anaesthesia. Group II patients (combination group) received preloading with 7.5 ml/kg/min of Ringer's lactate over 10 minute period preceding the spinal block followed by intravenous bolus of 2.5 mg ephedrine in the first and second minute and 2.5 mg ephedrine every 5 minutes for the next 20 minutes after the injection of spinal anesthetic drug. Non-invasive measurement of mean arterial pressures, heart rate, reactive hypertension, nausea and vomiting were documented. RESULTS: The incidence of hypotension following the subarachnoid block in Group I (ondansetron group) was 17.6% versus group II (combination group) was 13.3%, while difference among the groups is statistically insignificant (P = 0.082). Group IV fluids alone could reverse hypotension in 57.1% of patients in group I 33.3% in group II. 42.9% of patients in group I and 67.7% in group II could not be managed with IV fluids alone and had to be treated with 5 mg boluses of ephedrine for reversal of hypotension. The difference in the mean number of fluid boluses and a dose of ephedrine used between both groups was statistically insignificant (P = 0.11 and P = 0.21). HR showed a significant increase in group II and a statistically insignificant change in group I with a statistically significant difference in the heart rate (HR) between both groups (P < 0.05). Reactive hypertension, nausea and vomiting between both groups were statistically insignificant. CONCLUSION: The preemptive use of Ondansetron alone versus combined vasoconstrictors with fluid preload significantly reduces the incidence of post-spinal hypotension (PSH) with no significant difference between both regimens. Furthermore, they also reduced consumption of the used vasoconstrictors and fluids to correct hypotension.

scholarly journals Efficacy and Safety of Prophylactic Intrathecal Normal Saline for Prevention of Post Dural Puncture Headache among Women Undergoing Cesarean Section under Spinal Anesthesia: A Randomized Controlled Trial

2021 ◽  
Author(s):  
Semagn Abate ◽  
Siraj Ahmed ◽  
Getachew Mergia Anbese
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Normal Saline ◽  
Dural Puncture ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Repeated Measurements ◽  
Epidural Needle ◽  
Post Dural Puncture Headache ◽  
Resource Limited

Abstract Background: Post-Dural Puncture Headache is the commonest complication of spinal anesthesia. Body of evidence revealed that Conservative management failed to show significant benefit and epidural needle and catheter techniques didn’t provide conclusive evidence. On the other hand, intrathecal injection of normal saline is a simple technique and cost-effective in a resource-limited setup but it is not well examined on its effectiveness and safety profiles.Methods and materials: After Obtaining Ethical clearance from IRB, 152 mothers scheduled for cesarean section under spinal anesthesia were allocated randomly into two groups. Data analysis was done with SPSS version 22. Descriptive statistics were run to see the overall distribution of the study subjects. Unpaired student’s T-test for continuous symmetric data and Mann-Whitney U test for non-normally distributed data were used. Categorical data were analyzed with Chi-square and fisher’s exact test where appropriate. A generalized estimating equation model was used to investigate the interaction of repeated measurements of NRS pain scores of PDPH. Result: The overall incidence of PDPH was 29.6% while the proportion of patients who experienced PDPH was the highest among patients with control as compared to intervention( 36.8% vs 22%) respectively. The GEE model revealed that the NRS pain score was 0.7, 0.4, and 0.2 unit higher at 12, 24, and 48 respectively in control as compared to the interventionConclusion: prophylactic intrathecal normal saline could be an option in a resource-limited setup where the appropriate spinal needle is not accessible and management of moderate and severe PDPH is not feasibleRegistration: The protocol was registered prospectively in Clinical Trials.gov (NCT04393766).

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