Taylor 접근법은 경막천자 후 두통의 빈도를 감소시킨다

Background : The development of postdural punctute headache is related to a patients age, size, pregnancy, sex, type of dural puncture needle and direction of the needle bevel. We studied the effect of the needle size and type of dural puncture on postduzal puncture headache after spinal anesthesia in the 40 patients. Methods: Forty patients, belonging to ASA classes 1 and 2, were divided into 2 groups, one using the lumbar paramedian approach (n =20, Group 1) on L4-5 intaspinous space with a 24 G spinal needle and the the other using Taylors approach (n= 20, Group 2) through S2 foramen with a 22G spinal needle. All patients received an infusion of lactated Ringer's solution (1,000 ml). After spinal anesthesia, we measured the incidence, onset, duration and severity of postdural puncture headache in the 40 patients. Results : The incidence of postdural puncture headache is lower in Group 2 (0%) than in Group 1 (15%). The onset of postdural puncture headache occured within 24 hours in 100% of the patients in Group #1 and the duration of postdural puncture headache occured within 48 hours in 66.7% of the patients in Group 1. The severity of postdural punciure headache was mild and moderate in 3 cases of all the 3 cases with postdural puncture headache of Group 1. lhe location of postdural puncture headache was frontal in 2 cases and occipital in 1 case. Conclusions : The incidence of postdural puncture headache is zero in Taylors approach group in 20 patients. Thetefore we think that spinal anesthesia using Taylors approach is safer than spinal anesthesia with the lumar approach for postdural puncture headache. (Korean J Anesthesiol 2000; 39: 51~55)