الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
This study was conducted at EL-Minia University Hospital during the period from March 2011 to October 2011, Approval for the study was given by our anesthesia department and all patients gave informed consent before their inclusion in the study. A total of three hundred obstetric female patients in child bearing period (16-45yrs), belonging to ASA grade I or II undergoing elective or emergency caesarean section were selected.
Patients were randomly divided into three groups; Group I: received spinal anesthesia with traditional cutting 25-gauge Quincke spinal needle and had 2.6 ml of 0.5% hyperbaric bupivacaine injected intrathecally. Group II: received spinal anesthesia with traditional cutting 25-gauge Quincke spinal needle and had 2.2 ml of 0.5% hyperbaric bupivacaine with 20 ug fentanyl (total volume 2.6 ml) injected intrathecally. Group III: received spinal anesthesia with 25-gauge pencil-point Whitacree spinal needle and had 2.6 ml of 0.5% hyperbaric bupivacaine injected intrathecally
The aim of this study was to compare 25-gauge pencil-point spinal needle with 25-gauge Quincke spinal needle as regard post-dural puncture headache and to know the effect of addition of intrathecal fentanyl to LA, with use of traditional short- bevelled spinal needle on decreasing incidence of PDPH.
Heart rate, ECG, arterial oxygen saturation and non-invasive blood pressure monitoring were applied before induction of anesthesia using PCI monitor (model advisor USA).
The parameters that were assessed included: hemodynamics (HR, systolic and diastolic BP), arterial oxygen saturation, quality of anesthesia, maternal side effects and duration of effective analgesia. PDPH was also assessed regarding its incidence, onset, duration, location, severity and associated symptoms).
No significant differences in demographic and operative data were found between the 3 groups. Also, there was no significant difference regarding SpO2 among the 3 groups during the surgery
In our study, out of the total 300 patients; 9, 5 and 1 patients had PDPH in group I, II and III respectively. There was a significant reduction in the incidence of PDPH with use of the pencil-point spinal needle in group III, compared with the cutting spinal needle in group I (1% vs. 9%). The addition of intrathecal fentanyl may decrease the risk and severity of PDPH. Less patients in group II (25G Quincke spinal needle with intrathecal fentanyl) developed PDPH than in group I (25G Quincke needle without intrathecal fentanyl) [5% vs. 9%], although the difference was not statistically significant. None of the patients in group II or III had severe headache. Two out of 9 patients in group I had severe headache. The incidence of PDPH with the pencil-point needle in group III was lower than its incidence in group II, where cutting needle was used with intrathecal fentanyl, but the difference was not statistically significant.
Our study revealed better hemodynamic stability in group II (where fentanyl was added to the LA, allowing reduction of bupivacaine dose) compared with groups I and III (larger bupivacaine dose). This was indicated by the greater significant decrease of systolic and diastolic BP at 1 min. post induction in groups I & III compared with group II. Also, more hypotensive episodes occurred in groups I and III, compared with group II.
Bradycardia was seen intraoperatively and was comparable in the three groups, indicating that heart rate was not influenced by intrathecal fentanyl. The tachycardia which occurred 5min. postinduction is due to effect of ecobolics.
The addition of fentanyl to spinal bupivacaine improved the quality of surgical anaesthesia and prolonged the postoperative analgesia in group II compared to other groups. The time for the first request for analgesics was significantly delayed in group II when compared with other groups (P<0.01). Intrathecal fentanyl did not affect the degree of motor block.
Among the intraoperative maternal side effects, incidence of pruritis in group II, due to intrathecal fentanyl, was 36%, most of them were mild.
In our study, less emetic episodes occurred in group II, compared to other groups I and III (P<0.05). Shivering was comparable in the three groups (30%, 25% and 28% in groups I, II and III respectively).