title: Injection of intrathecal normal saline in decreasing postdural puncture headache.
abstract: OBJECTIVE
  Postdural puncture headache (PDPH) is the most common and still unresolved postoperative complication of spinal anesthesia. Although there are several positive results of intrathecal saline injection for the treatment of PDPH and prophylaxis after accidental dural puncture, the effect of deliberate intrathecal saline injection before spinal anesthesia has not been examined. The objective of our study was to evaluate the effect of prophylactic administration of intrathecal normal saline in decreasing PDPH.
  
  
  METHODS
  One hundred healthy women (ASA physical status I) of age between 18 and 35 years scheduled for elective term cesarean delivery under spinal anesthesia were included. Patients were randomly divided into two equal groups. Group C received 2.5 ml (12.5 mg) hyperbaric bupivacaine 0.5 % as a control, and group S received intrathecal normal saline 5 ml before intrathecal injection of 2.5 ml (12.5 mg) hyperbaric bupivacaine 0.5%. The incidence and severity of PDPH were assessed after 48 h and again 3-7 days after operation.
  
  
  RESULTS
  Basal characteristics were statistically similar in both groups (P > 0.05). The incidences of moderate and severe PDPH during first postoperative 48 h were not different between the groups (P = 0.24). However, the frequency of PDPH after 3-7 days was statistically higher in group C in compared with group S (16 vs. 2 %, P = 0.03). Totally the frequency of PDPH was higher in group C (24 vs. 2%, P = 0.002).
  
  
  CONCLUSIONS
  Administration of normal saline (5 ml) before intrathecal administration of hyperbaric bupivacaine as a preventive approach is an effective and simple way to minimize PDPH in patients undergoing cesarean section.
authors.affiliation: Department of Anesthesiology, Arash Women's Hospital, Tehran University of Medical Sciences, Rashid Ave., Resalat Highway, P.O. Box: 1653915981, Tehranpars, Tehran, Iran, nfaridi@sina.tums.ac.ir.
authors.forename: Nasrin
authors.initials: N
authors.lastname: Faridi Tazeh-Kand
authors.forename: Bita
authors.initials: B
authors.lastname: Eslami
authors.forename: Soghra
authors.initials: S
authors.lastname: Ghorbany Marzony
authors.forename: Robabeh
authors.initials: R
authors.lastname: Abolhassani
authors.forename: Khadijeh
authors.initials: K
authors.lastname: Mohammadian
mesh_terms: D000293:Adolescent; D000328:Adult; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D051299:Post-Dural Puncture Headache / Q000209:etiology* / Q000517:prevention & control*; D011247:Pregnancy; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D012965:Sodium Chloride; D002045:Bupivacaine
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