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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Prone position: A possible method to decrease post dural puncture headache (PDPH) during surgery.

Reza Alizadeh1, Ziba Aghsaeifard2, Bahar Fereydoonnia1

  • 1Department of Anesthesiology and Intensive Care, School of Medicine, AJA University of Medical Sciences, Tehran, Iran.

Annals of Medicine and Surgery (2012)
|February 11, 2022
PubMed
Summary

Choosing the prone position during surgery significantly reduces the risk of postdural puncture headache (PDPH) after spinal anesthesia. This surgical positioning is a reliable method to prevent this common complication.

Keywords:
CSF, cerebrospinal fluidEpidural puncturePDPH, Postdural puncture headachePostdural puncture headacheProne positionSpinal anesthesiaSpinal punctureSupine position

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Surgical Patient Positioning

Background:

  • Postdural puncture headache (PDPH) is a debilitating complication following spinal and epidural anesthesia.
  • PDPH is characterized by severe positional headaches, nausea, and vomiting, impacting patient recovery.
  • The choice of patient positioning during surgical procedures may influence the incidence of PDPH.

Purpose of the Study:

  • To compare the incidence of postdural puncture headache (PDPH) between patients operated in prone versus supine positions.
  • To evaluate the effectiveness of surgical positioning in mitigating the risk of PDPH after spinal anesthesia.

Main Methods:

  • A cohort study involving 1416 patients undergoing spinal anesthesia between June 2019 and June 2020.
  • Patients were assigned to either prone (444 patients) or supine (972 patients) positions based on surgical requirements.
  • Standardized spinal anesthesia techniques were employed, including 18-gauge cannula insertion and 26-gauge Quincke needle placement.

Main Results:

  • A significantly lower incidence of PDPH was observed in the prone group (0.68%) compared to the supine group (8.95%).
  • The odds ratio for developing PDPH when operated in the supine position was 13.16 (P < 0.001).
  • Only 3 patients in the prone group experienced PDPH, primarily those with pilonidal sinus requiring prone surgery.

Conclusions:

  • The prone position during surgery is a highly effective strategy for reducing the incidence of postdural puncture headache.
  • Implementing prone positioning can be a reliable method to prevent PDPH in patients receiving spinal or epidural anesthesia.