Spinal anesthesia in patients undergoing developing postspinal headache incidence and predisposing factors

VII. SUMMARYAim:To evaluate the headache incidence developed consecutively to spinal anesthesia, related factors and the treatments efficacy by prospective observational method on patients admitted to our clinic and administered spinal anesthesia.Materials and Methods:602 patients between ages 18-65 and ASA I-III were included in this study. Through the L2-3, L4-5 intervals, using 25 G and 26 G Quincke and pencil point spinal needles the patients were applied spinal anesthesia. The patient?s gender, age, body mass index and whether they were experiencing chronic headache prior to the surgery were recorded. The time of the day which reveals the doctor?s experience and the physical status was recorded. The type (isotonic NaCl, ringer lactate colloidal) and amount of the fluids administered intra-operatively were recorded. The spinal anesthesia levels and mobilization times were recorded. The patients were followed up on the first 24th , 48th and 72nd hours in the hospital and on the 7th day they were reached at home by phone to question if they had headaches and if they did, whether it is accompanied by nausea - vomiting and tinnitus. The patients considered as headache (+) were given medical treatment for 24 hours and the ones who didn?t respond to the treatment were planed to epidural blood patch aplication.Results:Headaches were most frequently observed on patients between 26-40 ages, with quincke type needles, those undergoing cesarean operations, following spinal anesthesia by inexperienced and physically tired performers. Gender, the duration between two spinal anesthesia, body mass index, fluid type and amount administered during the intraoperative period, the spinal anesthesia sensorial block level and the time of the mobilization were observed to not effect the headache incidence.Discussion:Studies reported that the headaches were most frequently seen in young patients, when quincke type needles were used and those undergoing cesarean operations. PDPH is less frequently observed with pencil point needles compared to quincke type needles (p<0.003) . Compared to older patients, 26-40 years old patients (p<0.001) and compared to other operations, following C/S (p<0.003) patients had headaches more frequently. One of the important factors is the experience (p<0.013) and the physical tiredness status on that day (p<0.001) of the performer.Conclusion:In our opinion, the application of spinal anesthesia by experienced and who are not physically tired performers with pencil point spinal needles will decrease the headache incidence rate.