مقایسه دو روش مدین و پارمدین در میزان بروز pdph در بیماران تحت عمل جراحی ارتوپدی اندام تحتانی به وسیله بی حسی نخاعی: یک مطالعه کارآزمایی بالینی تصادفی شده دوسویه کور

ﻣﻘﺪﻣﻪ: ﺑﯽﺣﺴﯽ 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 در ﻣﯿﺰان ﺑﺮوز ﺳﺮدرد ﭘﺲ از ﺑﯽﺣﺴﯽ ﻧﺨﺎﻋﯽ post dural puncture headache, pdph در ﺑﯿﻤﺎران ﺗﺤﺖ ﻋﻤﻞ ﺟﺮاﺣﯽ ارﺗﻮﭘﺪی اﻧﺪام ﺗﺤﺘﺎﻧﯽ ﺑﺎ ﺑﯽﺣﺴﯽ ﻧﺨﺎﻋﯽ اﻧﺠﺎم ﺷﺪ. روش ﮐﺎر: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﮐﺎرآزﻣﺎﯾﯽ ﺑﺎﻟﯿﻨﯽ دوﺳﻮﯾﻪ ﮐﻮر روی 60 ﺑﯿﻤﺎر ﮐﺎﻧﺪﯾﺪ ﻋﻤﻞ ﺟﺮاﺣﯽ ارﺗﻮﭘﺪی ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪه ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن ﭘﯿﻤﺎﻧﯿﻪ 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 ﺑﯽﺣﺴﯽ داﺧﻞ ﻧﺨﺎﻋﯽ و ﺑﻌﺪ از آن در دﻗﺎﯾﻖ 60 ،45 ،30 ،15 ،5 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. دادهﻫﺎ 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 اﻧﺪازهﻫﺎی ﺗﮑﺮاری، ﻣﺮﺑﻊ ﮐﺎی، ﻓﺮﯾﺪﻣﻦ و ﺗﯽ ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ ﺷﺪﻧﺪ. ﯾﺎﻓﺘﻪﻫﺎ: در ﻣﻘﺎﻃﻊ زﻣﺎﻧﯽ ﻗﺒﻞ از ﺑﯽﺣﺴﯽ داﺧﻞ ﻧﺨﺎﻋﯽ، ﺑﻼﻓﺎﺻﻠﻪ ﺑﻌﺪ از ﺑﯽﺣﺴﯽ و 5 دﻗﯿﻘﻪ ﺑﻌﺪ از آن ﺑﯿﻦ ﮔﺮوهﻫﺎی ﻣﺪﯾﻦ و ﭘﺎراﻣﺪﯾﻦ از ﻧﻈﺮ ﻣﯿﺎﻧﮕﯿﻦ ﺿﺮﺑﺎن ﻗﻠﺐ ﺗﻔﺎوت ﻣﻌﻨﺎداری وﺟﻮد داﺷﺖ p <0.05 . 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 زﻣﺎنﻫﺎی ﻣﺨﺘﻠﻒ وﺟﻮد ﻧﺪارد0/05< p ﻧﺘﯿﺠﻪﮔﯿﺮی: اﮔﺮﭼﻪ ﻣﺰاﯾﺎی ﻣﺘﻌﺪدی ﺑﺮای ﻫﺮﮐﺪام از روشﻫﺎی ﻣﺪﯾﻦ و ﭘﺎراﻣﺪﯾﻦ ذﮐﺮ ﺷﺪه اﺳﺖ، اﻣﺎ در راﺑﻄﻪ ﺑﺎ ﺑﺮوز ﺳﺮدرد، در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻔﺎوت ﻣﻌﻨﺎداری ﺑﯿﻦ دو روش ﻣﺪﯾﻦ و ﭘﺎراﻣﺪﯾﻦ ﮔﺰارش ﻧﺸﺪ. ﺑﻨﺎﺑﺮ اﯾﻦ، ﺑﺎ اﻧﺠﺎم ﻣﻄﺎﻟﻌﺎت ﺑﯿﺸﺘﺮ ﺑﺎ ﺗﺎﮐﯿﺪ روی رﺿﺎﯾﺖ ﻣﻨﺪی ﺑﯿﻤﺎران ﻣﯽﺗﻮان ﺑﻬﺘﺮﯾﻦ روش ﺑﯽﺣﺴﯽ داﺧﻞ ﻧﺨﺎﻋﯽ را اﻧﺘﺨﺎب و ﺑﻪ ﮐﺎر ﮔﺮﻓﺖ.

comparison of medin and parmadin methods in incidence post-dural-puncture headache (pdph) in patients undergoing orthopedic lower extremity surgery by spinal anesthesia

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. methods: this double-blind clinical trial was performed on 60 orthopedic surgery patients referred to pimayeh hospital in jahrom. 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. results: , 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,