[Headache following dural puncture in pregnant patients at term. Comparative study with non-obstetric patients].
OBJECTIVE
To compare the incidence of postdural puncture headache after subarachnoid anesthesia with a 24G Sprotte needle among full-term obstetric patients as compared to non-obstetric patients.


METHODS
A total of 200 patients were studied prospectively, divided into 2 groups. Group 1 (n = 100) patients were delivered by cesarean section and group 2 (n = 100) patients underwent infraumbilical or traumatological surgery. All were ASA I-II and under 40 years of age. Hydration was accomplished with lactated Ringer's solution 400-1,000 ml before mid-line puncture. The anesthetic used in both groups was isobaric bupivacaine 0.5% with a vasoconstrictor. The incidence of arterial hypotension and accompanying symptoms was recorded; perioperative administration of vasoactive amines and anticholinergics and liquids administered was measured. Twenty-four to 48 hours later the patients were asked when they started walking and if postdural puncture headache was experienced.


RESULTS
Group 1 received smaller doses of bupivacaine (p < 0.05) and the incidence of arterial hypotension was greater (p < 0.01) and required increased administration of amines (p < 0.01) and perioperative fluid therapy (p < 0.001). No difference was found between the two groups either for time of start of ambulation or for incidence of headache, which was 1% in both groups.


CONCLUSIONS
The incidence of postdural puncture headache in obstetric patients is low and similar to that of non-obstetric patients when the 24G Sprotte needle is used.
Echevarría
M
M
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de Valme, Sevilla.
Caba
F
F
Olmedo
L
L
Cruz
A
A
Llamas
J M
JM
Rodríguez
R
R
D000293:Adolescent; D000328:Adult; D000773:Anesthesia, Obstetrical / Q000009:adverse effects* / Q000295:instrumentation; D000775:Anesthesia, Spinal / Q000009:adverse effects* / Q000295:instrumentation; D002585:Cesarean Section; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D005440:Fluid Therapy; D006261:Headache / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000150:complications / Q000517:prevention & control; D015994:Incidence; D011247:Pregnancy; D011446:Prospective Studies; D013346:Subarachnoid Space
Cefalea pospunción dural en gestantes a término. Estudio comparativo con pacientes no obstétricas.