line"> <Introduction: Post Dural Puncture Headache (PDPH) is a relatively common
complication aftr spinal or epidural anesthesia, myelography and lumbar puncture. Despite
numerous studies that have identifid many therapies, debate and survey continues on the
best technique to prevent this complication. Threfore, the purpose of this study was to
evaluate the ''Reverse Flow" technique in prevention of headache aftr dural puncture in
cesarean section under spinal anesthesia.
Methods: In this single blind, simple randomized clinical trial, patients were divided
to two groups: intervention and control. Each group constituted of 120 patients. In the
intervention group we mixed 3 mL Marcaine 0.5% with 1 cc fentanyl and injected 3
mL of this mixture into subarachnoid space by 24-gauge quincke spinal needle then
simultaneously with injection of 1mL of this mixture, the needle was withdrawn. In the
control group only 3 mL of this was mixture was injected into subarachnoid space and we
had no injection while needle withdrawing. Thn we evaluated headache at 6, 12, 18, 24,
48 and 72 hours aftr the operation and if patients had headache we determined severity of
pain with the Numerical Rating Scale.
Results: Incidence of headache in the intervention group was 2.5% and 9.2% in the control
group (P = 0.028). Th average severity of headache was 5.66 ± 3.21 in the intervention
group and 5.18 ± 2.89 in the control group (P = 1). Th mean age was 29.26 ± 5.95 in
the control group and 27.89 ± 5.58 in the intervention group (P = 0.066). Th mean age
in patients, who suffred from headache, was 24.66 ± 3.05 in the intervention group and
29.72 ± 6.54 in the control group (P = 0.23). Patients who complained of headaches were
younger than others.
conclusions: Ths study indicated that use of "Reverse Flow" technique in cesarean
section under spinal anesthesia reduces PDPH. Th incidence of PDPH in patients, who
have not received this technique, was 3/7 times more than patients, who have received this
technique. Also the onset of headache in the control group happened earlier than in the
case group.