Comportamiento de la cefalea postpunción dural en pacientes quirúrgicos. Dos años de estudio.

La cefalea postpuncion dural es una complicacion postoperatoria que se describe con relativa frecuencia, variando su presentacion segun determinados factores de riesgo, por lo que se define como objetivo de la investigacion identificar el comportamiento de la cefalea postpuncion dural en pacientes intervenidos quirurgicamente durante 2 anos en el Hospital General de Trinidad, para ello se realizo un estudio descriptivo, prospectivo, que incluyo 940 pacientes intervenidos quirurgicamente, en forma electiva con anestesia espinal, obteniendose como resultados que la cefalea postpuncion dural se presento en 3.51% de los casos, el grupo de edades mas afectado fue el de 15 a 29  anos, los pacientes de 60 anos y mas no presentaron esta complicacion; y fue mas frecuente entre las mujeres. Se encontro ademas una mayor incidencia en aquellos donde se empleo para la puncion lumbar un trocar de mayor diametro; no se encontro dependencia con la deambulacion precoz y la incidencia de cefalea aumento en pacientes que recibieron menos de 2000 ml de hidratacion perioperatoria; asimismo aparecio tipicamente entre las 12 y 24 horas y en la mayoria de los casos resolvio en las primeras 72 horas del tratamiento impuesto. Llegando a las conclusiones de que la cefalea postpuncion dural disminuyo a medida que se incremento la edad y al emplear un trocar de menor calibre para la puncion lumbar, la deambulacion en las primeras 24 horas del postoperatorio no fue un factor determinante en la aparicion de la misma y los pacientes que recibieron menos de 2000 ml de hidratacion perioperatoria tuvieron una mayor incidencia de cefalea.   Dural punction-induced migraine  is a postoperative complication that is described with relative frequency, with its presentation varying  according to certain factors of risk, Therefore, it is defined as the objective of this investigation to identify the status of dural punction  induced migraine in patients intervened surgically during 2 years at the General Hospital of Trinidad. To this aim, a descriptive, prospective study was made that included 940 patients intervened surgically, in an elective form with spinal anesthesia, obtaining as results that dural punction-induced  migraine was present in 3.51% of cases. The most affected age  group was the one from 15 to 29 years. The 60 year-old patients and older didn't have this complication; and it was more frequent among women. There was also a  greater incidence in those in whom a trocar with a greater diameter was used for lumbar punction. No dependence was found with precocious ambulation, and  migraine incidence increased in patients that received less than 2000 ml of perioperative hydration. Also, it appeared typically between the first 12 and 24 hours, and in most cases it resolved in the first 72 hours of the imposed treatment. It was concluded that the dural punction-induced migraine puncion diminished as  age increased and when using a trocar of a smaller caliber for lumbar punction. Ambulation in the first 24 hours of the postoperative period was not a decisive factor in its appearance and the patients that received less than 2000 ml of hydrate perioperatively had a greater incidence migraine.