Annales chirurgiae et gynaecologiae
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Clinical Trial Controlled Clinical Trial
The prevention of headache following spinal anaesthesia.
The efficacy of various methods in preventing headache following spinal anaesthesia was compared in 797 patients. The postspinal headache occurred in 17.8% of the patients in whom the lumbar puncture was done with a 22-gauge needle. The use of a 26-gauge needle reduced the occurrence of the headache to 7.8% (p less than 0.0125) and the administration of 100 mg of indomethacin six hours after the blockade to 10.3% (p less than 0.05) of the patients. ⋯ In the patients with postspinal headache indomethacin relieved pain as effectively as a stronger analgesic-mixture. Other complaints occurring after the blockade were: pain in the lower back in 9.7% and pain in the lower extremities in 7.2% of the patients. The lithotomy position during the blockade predisposed the patients to these complications.
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Full-thickness abdominal wall defects are mainly traumatic or infectious in origin. After adequate resuscitation, treatment of associated visceral trauma, antibiotic therapy and careful debridement to vital tissues, primary repair of the abdominal wall should be carried out by simple methods by using synthetic mesh and/or split skin grafts. Local pedicle skin flaps or musculocutaneous flaps are advocated for secondary repair of the abdominal wall and also used in elective tumour surgery when total resection of the abdominal wall is indicated.