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Incidence, morbidity and treatment of headaches in post-hospital school spinal puncture: prospective study

Grant number: 11/19199-6
Support type:Regular Research Grants
Duration: February 01, 2012 - January 31, 2014
Field of knowledge:Health Sciences - Medicine - Surgery
Principal Investigator:Geraldo Rolim Rodrigues Junior
Grantee:Geraldo Rolim Rodrigues Junior
Home Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil


Headache after spinal puncture (CPPSA) is important complication and relatively common1-2, after completion of anesthetic procedures, especially in obstétricia1, which aim to reach the subarachnoid space using a series of needles. The incidence varies between 6% and 36% 3. She was described in 1898 by August Bier using cocaine in the subarachnoid space to cause anesthesia espinhal4. This author postulated that CPPSA would result from loss of cerebrospinal fluid (CSF), after observing the next morning, headaches that arose and increased in intensity, while abandoning the supine position (DDH) 5. The relief would also be observed to return home in DDH. Bier described, and also experienced these symptoms when performing the procedure itself próprio5.In obstetric anesthesia CPPSA is the third leading cause of lawsuits against anestesiologistas11The International Headache Society defines CPPSA as headache started within 7 days after lumbar puncture, disappearing in 14 days3. The headache begins or worsens within 15 minutes after taking up the supine position and would disappear or improve after taking 30 minutes to rest position (DDH) 4-5. The head pain is felt in areas frontal, occipital, or both can and usually involve the neck and ombros13However, the cause remains CPPSA incerta6. It is possible that the pressure of the cerebrospinal fluid (CSF) 1, resulting from the loss of the hole punção2, 4-5, is greater than its production by the choroid plexus responsible for most of the production of LCR2, 6The difficulties caused by the headache and its treatment cause great discomfort to patients, making recovery longer, prolonging their length of stay and resulting in increased hospital costs. Eighty-six percent of patients suffering from CPPSA undergoing treatment and would never choose the same anesthesia novamente12. In this same group, 72% would not recommend to friends or relatives and 77% complained of lack of information about the risk of headache, or after accidental puncture with epidural needle, or as a result of spinal simples12.The scope of this study, in view of the lack of data in this hospital, is to draw an updated profile of this true endemic, exposing incidence, morbidity, and treatment costs. (AU)