Can we predict who will complain postspinal headache? Role of matrix metalloproteinases

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GÜNAYDIN D. B., Uysal M., ATAK YÜCEL A., GÜLBAHAR Ö., UĞRAŞ DİKMEN A., Akın S.

EUROANAESTHESIA2019, viyana, 1 - 03 Haziran 2019, cilt.36, sa.4101, ss.112

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Cilt numarası: 36
  • Basıldığı Şehir: viyana
  • Sayfa Sayıları: ss.112
  • Gazi Üniversitesi Adresli: Evet

Özet

04AP10-1

Can we predict who will complain postspinal headache after cesarean delivery? Role of matrix metalloproteinases

Gunaydin D. B.1 , Uysal M.2 , Atak A.3 , Gulbahar O.4 , Dikmen A. U.5 , Akın S.6 1

Gazi University School of Medicine - Ankara (Turkey), 2 Gazi University School of Medicine, Anesthesiology - Ankara (Turkey), 3 Gazi University School of Medicine, Immunology - Ankara (Turkey), 4 Gazi University School of Medicine, Biochemistry - Ankara (Turkey), 5 Gazi University School of Medicine, Statistics - Ankara (Turkey), 6 Gazi University School of Medicine, Neurology - Ankara (Turkey)

Background and Goal of Study: Matrix metalloproteinase (MMP) family has a role in remodeling of extracellualr matrix as a physiologic process or may cause pathologic conditions like cancer and inflamatory or neurologic diseases. Particularly MMP-9, which is structurally a gelatinase and released from neutrophils by exocitosis, might have a critical role in wound healing via angionesis. Therefore, incidence of postspinal headache might be related to MMP-9 levels. Hereby, we aimed to investigate whether there is an association between postspinal headache incidence and MMP-9 levels in parturients scheduled for elective cesarean section under spinal anesthesia using different diameters of spinal needles.

Materials and Methods: After ethics committee approval, parturients were randomly assigned to 2 groups to perform spinal anesthesia with either 25 or 27 gauge (G) spinal needles. Each group’s name were initially enclosed which type of spinal needle to be used before onset of study.After disinfection and local anesthetic infiltration into skin, spinal block was performed using either 25 G (n = 87) or 27 G (n = 82) spinal needle in the sitting position. When free flow of cerebrospinal fluid (CSF) was observed, 1 ml of CSF was collected to be stored in -80°C for further biochemical analysis of MMP-9 levels via ELISA. Then 12 mg of hyperbaric bupivacaine with fentanyl 10 µg+morphine 100 µg was administered intrathecally. After achieving a sensory block level at T4 dermatome, onset of surgery was allowed. Patients were questioned for postspinal headache at postpartum 48 hours at the hospiatl and called 5 days after discharge to check whether there was a postspinal headache or not at home. Kolmogorow simirnov and chi square tests were used. P value less than 0.05 was considered as statistically significiant.

Results and Discussion: MMP-9 levels in CSF were significantly higher in subjects underwent spinal anesthesia with 27 G. Although healing of dural hole could have been expected to be faster, rate of postspinal headache was comparable. Group 25 G n=87 Group 27 G n=82 p MMPs-9 in CSF (ng/L) median 74.7 365.3 0.0001 Postspinal headache rate % 25.3 14.6 0.124 Conclusions: Analyses of CSF biomarkers might imply a pathophysiological role in ...................................................................................................................................