miércoles, 17 de diciembre de 2014


¿La gabapentina preoperatoria afecta las características de la CPPD en las parturientas con raquia para cesárea? 

Does preoperative gabapentin affects the characteristics of post-dural puncture headache in parturients undergoing cesarean section with spinal anesthesia?
Nofal WH, Mahmoud MS, Al Alim AA.
Saudi J Anaesth. 2014 Jul;8(3):359-63. doi: 10.4103/1658-354X.136433.
BACKGROUND: Gabapentin is effective for treating different types of headache including post-dural puncture headache (PDPH), also used for prophylaxis against migraine. We studied the effect of pre-operative administration of gabapentin on the characteristics of PDPH in parturients undergoing cesarean section (CS) under spinal anesthesia. MATERIALS AND METHODS: Women undergoing elective cesarean section under spinal anesthesia were randomized to receive preoperative gabapentin 600 mg or placebo. Spinal anesthesia was achieved with 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl. Babies were followed up by Apgar scores, umbilical artery blood gases, breastfeeding difficulties, and need for NICU admission. The mothers were followed up for any side-effects of gabapentin for 24 h. Patients with PDPH were re-admitted and onset and duration of the headache were reported and severity was assessed using a visual analog scale (VAS) for 4 days from diagnosis. Paracetamol with caffeine and diclofenac were given for treatment, and the doses were adjusted according to VAS; also number of doses given for each group was recorded. RESULTS: Eighty eight patients were randomized, and 2 were excluded. The incidence of headache and co-existing symptoms were similar in both groups. The onset of headache was significantly delayed in gabapentin group (P < 0.05). Also, severity and duration of headache were significantly less in gabapentin group (P < 0.05). The incidence of sedation was more in gabapentin group 11 (26.19%) versus placebo group 3 (6.81%). Neonatal outcomes were statistically insignificant between both groups. CONCLUSION: Pre-operative administration of gabapentin has no effect on incidence of (PDPH) but delays its onset and reduces its severity and duration in parturients undergoing cesarean section with spinal anesthesia without significant adverse effects on the mother or the baby.
KEYWORDS: Gabapentin; PDPH; spinal anesthesia

Evaluación de los factores que afectan y la eficacia del tratamiento en los casos de CPPD que reciben parche peridural

Evaluation of affecting factors and the effectiveness of treatment in cases with post-dural puncture headache who underwent epidural blood patch.
Pirbudak L, Uğur MG, Kaya Uğur B, Kul S, Ganidağlı S.
Agri. 2014;26(3):101-6. doi: 10.5505/agri.2014.20591.
OBJECTIVES: We evaluated post dural puncture headache (PDPH) cases and the contributing factors and monitored the treatment response with epidural blood patch (EBP), and other therapies. METHODS: In this retrospective study, 77 PDPH cases treated with EBP were included. Patients were evaluated in terms of age, gender, type of surgery, type and diameter of the needle used for dural puncture, number(s) of dural puncture, onset of punctural headache, any conservative therapies for PDPH, number(s) of EBP application, analgesia quality at the 10th minute and 2nd hour after EBP application, and radicular pain during procedure. RESULTS: The mean age of 77 patients (46 female, 31 male) was 31.5 ± 11.3, and the most common surgery performed was cesarean section. More than one attempt was applied in 48 patients. In 37 cases, a 22G spinal needle was used, while a 25 G spinal needle was used in 20 cases. The mean duration of the headache was 3.1 ± 1.3 days for female patients and 4.6 ± 2.3 days for male patients (p=0.020). VAS significantly decreased and patient satisfaction significantly increased after the 10th minute in patients who had EBP (p=0.001). In only one case (2%), the second EBP was needed for pain relief. Transient radicular pain was observed in 17 cases (22.07%) at administration of EBP. CONCLUSION: In PDPH cases, EBP is an effective and relatively safe method, especially in obstetric patients. We reported that the PDPH symptoms presented earlier in female patients. A preference of a small diameter needle (less than 22 G) and avoidance of multiple attempts is important for spinal anesthesia.


Anestesiología y Medicina del Dolor

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