مجله علوم پزشکی پارس
مقایسه دو روش مدین و پارامدین در بروز سردرد پس ازبی حسی در بیماران تحت عمل جراحی ارتوپدی اندام تحتانی بابی حسی داخل نخاعی: یک مطالعه کار آزمایی بالینی تصادفی شده دوسویه کور
نوع مقاله : مقاله پژوهشی
نویسندگان
1 استادیار گروه ارتوپدی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.
2 کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.
3 گروه بیهوشی، مرکز تحقیقات بیهوشی و کنترل درد، دانشگاه علوم پزشکی جهرم، جهرم، ایران
چکیده
مقدمه: بی حسی داخل نخاعی متداول ترین روش انتخابی در جراحی ارتوپدی اندام تحتانی است. این روش با وجود داشتن فواید زیاد، عوارضی همچون سردرد در دوره حاد پس از عمل دارد. از این رو، مطالعه حاضر با هدف مقایسه دو روش مدین و پارمدین درمیزان بروز سردرد پس از بی حسی نخاعی (Post Dural Puncture Headache, PDPH) در بیماران تحت عمل جراحی ارتوپدی اندام تحتانی با بی حسی نخاعی انجام شد.
روش کار: این مطالعه کارآزمایی بالینی دوسویه کور روی 60 بیمار کاندید عمل جراحی ارتوپدی مراجعه کننده به بیمارستان پیمایه شهرستان جهرم انجام شد. بیماران به طور تصادفی به روش پرتاب سکه به دو گروه مدین و پارامدین تقسیم شدند. علائم حیاتی در مقاطع زمانی قبل از انجام بی حسی داخل نخاعی و بعد از آن در دقایق 5، 15، 30، 45، 60 و 90 حین عمل جراحی و در زمان ریکاوری ثبت شد. میزان بروز سردرد پس از جراحی در بیماران به مدت هفت روز و هر روز یک مرتبه توسط فرد بی اطلاع از نوع پرسش نامه تعیین شد. داده ها با کمک نرم افزار SPSS نسخه 21 و استفاده از آمار توصیفی شامل میانگین، انحراف معیار، تعداد و درصد و همچنین آمار استنباطی شامل آزمونهای تحلیل واریانس با اندازه های تکراری، مربع کای، فریدمن و تی تجزیه و تحلیل شدند.
یافته ها: در مقاطع زمانی قبل از بی حسی داخل نخاعی، بلافاصله بعد از بی حسی و 5 دقیقه بعد از آن بین گروه های مدین و پارامدین، از نظر میانگین ضربان قلب تفاوت معناداری وجود داشت (0.05> P). در روز اول و چهارم، بروز سردرد در گروه پارامدین بیشتر از گروه مدین بود. اما نتایج نشان داد که تفاوت معناداری در این مورد بین دو گروه در زمان های مختلف وجود ندارد (0.05< P).
نتیجه گیری: اگرچه مزایای متفاوتی برای هر کدام از روش های مدین و پارامدین ذکر شده است، اما در رابطه با بروز سردرد، در این مطالعه تفاوت معنادری بین دو گروه مدین و پارامدین گزارش نشد. بنابراین با انجام مطالعات بیشتر با تاکید روی رضایت مندی بیماران می توان بهترین روش بی حسی داخل نخاعی را انتخاب و به کار گرفت.
کلیدواژه‌ها
عنوان مقاله [English]
Comparison of Medin and Parmadin methods in incidence Post-Dural-puncture headache (PDPH) in patients undergoing orthopedic lower extremity surgery by spinal anesthesia
نویسندگان [English]
- masomeh pourmokhtari 1
- Ali Pourhashemi 2
- navid kalani 3
1 Assistant Professor of Orthopaedics, Jahrom University of Medical Sciences, Jahrom, Iran.
2 Student research committee, Jahrom University of Medical Sciences, Jahrom, Iran
3 Department of Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
چکیده [English]
Introduction: The most common method of choice for orthopedic lower extremity surgery is intrathecal anesthesia.
Despite the benefits of using spinal anesthesia, this method has complications such as headache in the acute postoperative period. Therefore, this study aims to compare Madin and Parmadin methods. The incidence of PDPH (Post-Dural-puncture headache) in patients undergoing orthopedic lower limb surgery was performed by spinal anesthesia.
Materials and Methods: This double-blind clinical trial was performed on 60 orthopedic surgery patients referred to Pimayeh Hospital in Jahrom. Inclusion criteria included expressing consent to participate in the study, ASA class 1 and 2, no migraine and chronic headaches, no cardiovascular disease, no coagulation disease. Patients accidentally throwing coins into two groups 1) Medin And 2) paramedins were divided. Vital signs were recorded before and after spinal anesthesia at 5, 15, 30, 45, 60, and 90 minutes during surgery and in recovery. PDPH was collected in patients after surgery for 7 days and once a day by an uninformed person in the form of a questionnaire. After collecting data, the data were statistically analyzed using SPSS software version 21. To report descriptive statistics, qualitative variables were reported using frequency and percentage, and quantitative data were reported using mean and standard deviation.
Analysis of variance with repeated measures and Chi-square test were used. P <0.05 will be considered as a significant level.
Results: A total of 60 patients undergoing orthopedic surgery were evaluated by spinal anesthesia in the age range of 16 to 90 years (in two groups of 30). In pre-spinal anesthesia, immediately after spinal anesthesia, 5 minutes, 15 minutes and 30 minutes after spinal anesthesia, and in recovery, there was no significant difference between median and paramedic groups in mean systolic and diastolic blood pressure. (p>0.05). In the periods before spinal anesthesia, immediately after spinal anesthesia and 5 minutes after spinal anesthesia, there was a significant difference in mean heart rate between Medin and Paramedin groups (P <0.05). On the first and fourth days, the incidence of PDPH was higher in the paramedin group than in the medin group. But the results of statistical analysis showed that there was no significant difference between the two groups in the incidence of PDPH at different times (p <0.05).
Conclusion: Although different benefits have been mentioned for each of Madin and Paramedin methods, but in relation to the incidence of headache, in this study, no significant difference was reported between Madin and Paramedin groups. Therefore, with more studies and more studies related to patient satisfaction, the best method can be used in choosing intrathecal anesthesia technique.
کلیدواژه‌ها [English]
- Orthopedics
- Spinal Anesthesia
- PDPH
- Medin
- Paramedin
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