DURA PONKSİYONU SONRASI BAŞ AĞRISI VE TEDAVİSİ

Year 2018, Volume: 25 Issue: 1, 98 - 107, 01.03.2018

Mustafa Soner Özcan

https://doi.org/10.17343/sdutfd.308231

Cited By: 1

Abstract

ÖZET: Dural ponksiyon, farklı birçok disiplin
tarafından farklı amaçlar için sık uygulanan bir işlemdir. Anestezi pratiğinde
dural ponksiyon en çok istemli olarak subaraknoid blok ve istemeden epidural
anestezi sırasında gerçekleştirilir. Dura ponksiyonu sonrası baş ağrısı, August
Bier’in 1898’de ilk vakayı bildirmesinden beri bu işlemden sonra ortaya çıkan
sık ve ciddi komplikasyonlardan biridir. Son yıllarda geliştirilen küçük çaplı
iğneler ve özellikle pencil-point tipi iğnelerde baş ağrısı insidansı
geleneksel keskin Quinke tip iğnelere kıyasla oldukça azalmıştır. Baş ağrısı
genel olarak 2 hafta içerisinde kaybolsa da, aylar ve hatta yıllarca sürebilir.
Hastaların günlük yaşantısını ciddi anlamda bozan bu komplikasyon için değişik
tedavi modaliteleri bulunmuştur. Bunlardan güncel olarak ‘’altın standart’’
yöntem olarak görülen epidural kan yamasıdır. Dura ponksiyonu sonrası baş ağrısı,
farkedildiği andan itibaren dikkatlice izlenmeli, hızlıca tedavisine
başlanmalıdır. İnvaziv yöntemler, konservatif yöntemlere cevap vermeyen
vakalarda seçilmelidir. Oluşabilecek diğer hayatı tehlikeye sokabilecek
komplikasyonlar açısından dikkatli olunmalı ve ayırıcı tanı yapılmalıdır.

ABSTRACT: Dural puncture is a
common procedure used by many different disciplines for different purposes. In
anesthesia practice, dural puncture is mostly performed during subarachnoid
block as intentional and epidural anesthesia as unintentional. Post-dural
puncture heacache has been one of the most frequent and serious complications
since August Bier reported the first case in 1898. In recent years, the
incidence of headaches with small gauge needles, especially pencil-point type
needles, has been greatly reduced when compared to traditional cutting Quinke
type needles. Although headache generally ceases within 2 weeks, it may last
for months or even years. Various treatment modalities have been found for this
complication that seriously impairs the daily life of the patients. One of the
current methods is epidural blood patch which is regarded as ‘Gold Standard’. Post-dural
puncture headache should be followed up carefully as from the moment that it is
noticed, and treatment should be started quickly. Invasive methods should be
chosen for the cases who are unresponsive to conservative methods. It should be
careful for other life-threatening complications and definitive diagnosis
should be made.

Keywords

Dura Ponksiyonu Sonrası Başağrısı, Epidural Kan Yaması, Komplikasyonlar, Tedavi

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