Der Anaesthesist
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Randomized Controlled Trial Comparative Study Clinical Trial
[Post spinal headache. Its incidence following the median and paramedian techniques].
A lack of uniform methodology used by different authors in the assessment of different puncture techniques in spinal anesthesia formed the basis of the current study, which compared under randomized conditions the incidence of post spinal headache after a median or paramedian (lateral) approach. MATERIALS AND METHODS. Two hundred and fifty ASA physical status II and III patients, aged 50-85 years, scheduled for transurethral prostate surgery under spinal anesthesia were investigated. ⋯ The results indicate that the incidence of post spinal headache is higher in younger patients when using the paramedian (lateral) approach. However, our findings suggest that the choice of lumbar puncture technique--median or paramedian--is of little importance in regard to post-puncture headache in elderly patients. The paramedian approach is especially useful when degenerative changes are encountered in the interspinous structures in elderly patients, when an ideal position is difficult to achieve.
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Randomized Controlled Trial Clinical Trial
[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. ⋯ 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.