مقایسه دو روش مدین و پارامدین بر میزان بروز سردرد پس از بیحسی نخاعی در زنان تحت بیحسی اسپاینال: یک مطالعه مرور نظامند

نوع مقاله : مروری

نویسندگان

1 استادیار گروه بیهوشی، مرکز تحقیقات بیهوشی، مراقبت ویژه و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران.

2 دانشیار گروه بیهوشی، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

3 دانشیار گروه بیهوشی، مرکز تحقیقات بیهوشی، مراقبت ویژه و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی هرمزگان، بندرعباس، ایران.

4 متخصص بیهوشی و مراقبتهای ویژه، مرکز تحقیقات بیهوشی و کنترل درد، دانشکده پزشکی، دانشگاه علوم پزشکی جهرم، جهرم، ایران.

5 استادیار گروه بیهوشی، دانشکده پزشکی، دانشگاه علوم پزشکی قم، قم، ایران.

چکیده

مقدمه: سردرد پس از بی­ حسی نخاعی، یک مشکل شایع در زنان باردار تحت سزارین با بی­ حسی نخاعی می­ باشد. از بین روش­ های بی­ حسی ناحیه‌ای، بی­ حسی نخاعی یکی از رایج ­ترین روش­ ها جهت اعمال سزارین می­ باشد که عمدتاً با دو تکنیک مدین و پارامدین انجام می­ شود. بنابراین مطالعه حاضر با هدف مقایسه دو روش مدین و پارامدین بر میزان بروز سردرد پس از بی­ حسی نخاعی در زنان تحت بی ­حسی اسپاینال به‌صورت یک مطالعه مرور نظامند انجام گرفت.
روش‌کار: در این مطالعه مرور نظامند جهت یافتن مقالات مرتبط، پایگاه­ های اطلاعاتی Scopus، PubMed، Magiran، SID، Medlib، Cochrane، Science Direct و موتور جستجوگر Google Scholar با کلید واژه‌های فارسی مدین، پارامدین، سردرد پس از بی­ حسی نخاعی، سزارین، بی­ حسی اسپاینال و کلید واژه‌های انگلیسی Median، Paramedian، PDPH، Cesarean Section، Spinal Anesthesia به دو زبان فارسی و انگلیسی، بدون محدودیت زمانی تا تاریخ 20 اردیبهشت 1402 جستجو شدند. جهت ارزیابی کیفی مقالات از چک‌لیست جداد استفاده شد.
یافته ­ها: مطالعات وارد شده در مرور سیستماتیک شامل 11 مطالعه و محدوده انجام مطالعات بین سال ­های 2021-2009 بود. در مجموع 1195 بیمار با کلاس بیهوشی 1 و 2 وارد مطالعه شدند. در 4 مطالعه بین دو رویکرد مدین و پارامدین هیچ تفاوت آماری معنی‌داری بین دو گروه وجود نداشت. در 6 مطالعه روش پارامدین باعث بروز سردرد کمتر نسبت به مدین و در 1 مطالعه روش مدین باعث بروز سردرد کمتر نسبت به پارامدین شده بود.
نتیجه­ گیری: استفاده از روش پارامدین نسبت به تکنیک مدین می ­تواند باعث بروز کمتر سردرد پس از بی­حسی نخاعی بعد از عمل جراحی سزارین شود. پیشنهاد می­ شود متخصصین بیهوشی در صورت امکان از تکنیک پارامدین جهت بی­ حسی اسپاینال برای زنان تحت عمل جراحی سزارین استفاده کنند تا از بروز سردرد پس از بی­ حسی نخاعی بعد از عمل جراحی در این بیماران جلوگیری یا کاهش دهند.

کلیدواژه‌ها

عنوان مقاله [English]

Median versus paramedian methods on the incidence of postdural puncture headache in women under spinal anesthesia: a systematic review

نویسندگان [English]

  • Pourya Adibi 1
  • Reza Sahraei 2
  • Majid Vatankhah 3
  • Bibi Mona Razavi 1
  • Tayyebeh Zarei 1
  • Samira Zanbagh 1
  • Elahe Rahmanian 4
  • Somayeh Mehrpour 5
1 Assistant professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
2 Associate Professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
3 Associate Professor, Department of Anesthesiology, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
4 Anesthesiologist and Special Care specialist, Anesthesiology, Critical Care and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
5 Assistant Professor, Department of Anesthesiology, Faculty of Medicine, Qom University of medical sciences, Qom, Iran.
چکیده [English]

Introduction: Headache after spinal anesthesia is a common problem in pregnant women undergoing cesarean section with spinal anesthesia. Among the regional anesthesia methods, spinal anesthesia is one of the most common methods for cesarean section, which is mainly performed with median and paramedian techniques. Therefore, this systematic review study was conducted with aim to compare two methods of median and paramedian on the incidence of postdural puncture headache (PDPH ) in women under spinal anesthesia.
Methods: In this systematic review study, to find the related articles, Scopus, PubMed, Magiran, SID, Medlib, Cochrane, Science Direct databases and Google Scholar search engine were searched using the keywords of median, paramedian, postdural puncture headache, caesarean section, and spinal anesthesia in both Persian and English languages without time limit until 20 May 2023. Jadad checklist was used to evaluate the quality of the articles.
Results: The studies entered in the systematic review included 11 studies and the studies were conducted in 2009-2021. A total of 1195 patients with anesthesia class 1 and 2 were included in the study. In 4 studies, there was no statistically significant difference between the two groups of median and paramedian approaches. In 6 studies, the paramedian method caused fewer headaches than median method. In one study, median method caused fewer headaches than paramedian method.
Conclusion: The use of the paramedian method compared to the median technique can cause a lower incidence of PDPH after cesarean surgery. It is suggested that anesthesiologists use the paramedian technique for spinal anesthesia for women undergoing cesarean surgery, if possible, in order to prevent or reduce the occurrence of PDPH after surgery in these patients.

کلیدواژه‌ها [English]

  • Headache
  • Median
  • Paramedian
  • Spinal anesthesia

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مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 8
آبان 1402
صفحه 69-77

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