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The effect of Valsalva maneuver in attenuating skin puncture pain during spinal anesthesia: a randomized controlled trial

2016; Korean Society of Anesthesiologists; Volume: 69; Issue: 1 Linguagem: Inglês

10.4097/kjae.2016.69.1.27

2005-7563

Sanjay Kumar, Sujeet Gautam, Devendra Gupta, Anil Agarwal, Sanjay Dhirraj, Sandeep Khuba,

Anesthesia and Neurotoxicity Research

Background Valsalva maneuver reduces pain by activating sinoaortic baroreceptor reflex arc. We planned this study to evaluate the role of valsalva in attenuating spinal needle-puncture pain. Methods Ninety American Society of Anesthesiologists (ASA) grade I and II enrolled patients undergoing elective surgery were randomized into 3 groups of 30 each. Group I (Control): didn't blow; group II (Distraction): patients blew into rubber tube; Group III (Valsalva): blew into sphygmomanometer tube and raise mercury column up to 30 mmHg for at least 20 seconds. During above procedures, spinal puncture was performed with 25-gauge spinal needle. Results Eighty-two patient data were analyzed. Incidence of spinal puncture pain was reduced to 10% (3 of 27) in Valsalva group as compared to 100% (28 of 28 in control group and 27 of 27 in Distraction group) observed in other two groups (P < 0.05). Severity of lumbar puncture pain as assessed by visual analog scale (0−10; where 0 is no pain and 10 is the worst imaginable pain) presented as Median (Interquartile range) were significantly reduced in the Valsalva group (0.0 [0.0] as compared to other 2 groups 2.0 [0.0] in the Distraction group and 3.0 [0.8] in Control group) (P < 0.05). Regarding time taken by CSF to fill spinal needle hub, there was no difference among the three groups (P > 0.05). None patient of all groups had post dural puncture headache (P > 0.05). Conclusions Valsalva can be performed routinely in ASA I and II patients undergoing spinal anesthesia as it is safe, painless and non-pharmacological method of pain attenuation. Keywords: Distraction; Lumbar puncture pain; Spinal anesthesia; Valsalva maneuver; Visual analog scale.