Apfel cc, prevention of postdural puncture headache after accidental drual puncture. Patients with chronic headaches were reported to be more likely. Postpartum headache is a common symptom with multiple causes. Nonpharmacologic neuraxial interventions for prophylaxis of postdural puncture headache in the obstetric patient postdural puncture headache due to accidental dural puncture during epidural catheter placement is a source of morbidity for new mothers. The onset is usually within the first three days of the dural puncture 90% of pa tients and 66% starts in the first 48 hours 1 11 12. The following day the patient began to complain of a severe frontal headache with associated neck and back pain, characteristic of a post dural puncture headache pdph. Postdural puncture headache management headache is not an uncommon complaint during the postpartum period.
Spinal anesthesia is known to have numerous benefits, including reductions in nausea and opioid consumption. Article pdf available in korean journal of anesthesiology 702. Postdural puncture headache pdph is a complication of spinal anesthesia and unintentional dural puncture during attempted epidural anesthesia. The character of postdural puncture headache is throbbing and continuous. Postdural puncture subdural hematoma or postdural puncture. The incidence of post dural puncture headache following. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. Prevention of postdural puncture headache after accidental. Postdural puncture headache pdph is one of the most common complications encountered by physicians following spinal anesthesia or lumbar puncture. Postdural puncture headache pdph is a common complication after inadvertent dural puncture.
The literature specifically examining this complication in adolescents is scarce. Guidelines for the diagnosis, treatment and prevention of. Postduralpuncture headache an overview sciencedirect. Postdural puncture headaches revolutionary treatment for. Her history was complicated by previous multilevel spinal fusion with hardware. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. Outcomes included postdural puncture headache, any headache, need for iv fluid or controlled analgesia, need for epidural blood patch, success on first lumbar puncture attempt, nerve root. If you continue browsing the site, you agree to the use of cookies on this website.
A lumbar puncture is a diagnostic and therapeutic procedure in which a spinal needle is passed into the subarachnoid space. A postdural puncture headache pdph occurs after intentional in the case of spinal anesthesia or accidental in the case of epidural anesthesia puncture of the dura mater. Cosyntropin also reduced the need for epidural blood patch from 30% to 11%. Cathie lm sudlow, department of clinical neurosciences, university of edinburgh, western general hospital. An epidural blood patch was performed using 15 ml of autologous blood, which relieved her headache. Associate professor and director of obstetric anesthesiology. Postdural puncture headache in complex regional pain. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the.
Evidence based management of postdural puncture headache. Included studies compared atraumatic needles with conventional needles for lumbar puncture. Risk of postdural puncture headache in adolescents and. State of current practice there continues to be a lack of consensus among anesthesiologists regarding the management of postdural puncture headache24. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. Lumbar puncture knowledge for medical students and. The use of thin, atraumatic needles and special puncture techniques e. Study evaluating sphenopalatine ganglion block spgb for. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and. Articles published from january 1980 to april 1992 were obtained through a search of medline and index medicus. Headache following dural puncture is a typical complication of neuraxial analgesia and can impair the ability to perform activities of daily living up to incapacitation. Guidelines for the management of post dural puncture. Postdural puncture headache pdph can occur as a result of diagnostic lumbar puncture, spinal anaesthesia, and accidental dural puncture during epidural anaesthesia. It is exacerbated by movement and sitting or standing.
There is controversy over whether age and gender are independent risk factors for the development of postdural puncture headache. Postdural puncture headache in the obstetric patient. Cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. By dr saravanavel sagadai topic advisor, nhs evidence surgery, anaesthesia, perioperative and critical care and consultant in anaesthesia, james paget university hospitals nhs foundation trust and dr gokulnath rajendran st3 in anaesthesia, ipswich hospital, ipswich. Postdural puncture headache pdph is a potential expected complication of a lumbar puncture, with symptoms related to traction on painsensitive structures from low cerebrospinal fluid csf pressure intracranial hypotension following a leak of csf at the puncture site. Unintentional dural puncture and postdural puncture.
Subdural hematoma and postdural puncture headache from. The resulting loss in csf pressure leads to traction on the meninges and a severe headache, which is often positional and accompanied by. Postdural puncture headache pdph is an important iatrogenic cause of patient morbidity in modern anesthesia, pain management after attempted epidural blocks and after spinal taps. Use of intravenous cosyntropin in the treatment of. Carrie and collins define a pdph as a headache occurring after dural puncture that has a.
His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. Studies that did not include dural puncture were excluded. In this case, an epidural blood patch was performed using epidural catheter under fluoroscopic guidance to target the site of csf leak and to avoid damaging the intrathecal catheter. Subsequent to this procedure, 042% of the patients develop headache over the frontal and occipital areas radiating to the neck and shoulders.
Post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Exacerbation of the headache by adoption of the upright posture, and improvement of the pain by lying down is the sine qua non of postdural puncture headache pdph. Evaluation of post dural puncture headache using various sizes of. Postdural puncture headache pdph is a benign condition and the most frequent complication of spinal anesthesia. Epidural blood patch cures postdural puncture headache in 90% of cases d. Full text is there a difference in postdural puncture. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Study evaluating sphenopalatine ganglion block spgb for treatment of postdural puncture headache pdph pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Inadvertent dural puncture during epidural anesthesia is a more common cause of pdph than spinal anesthesia because of the use of small. Postdural puncture headache pdph was perhaps the first recognized complication of regional anesthesia.
St georges hospital london guidelines for the diagnosis, treatment and prevention of post dural puncture headache diagnosis of headache headache is common in the postpartum period, affecting up to 40% of all parturients. Postdural puncture headache is the most frequent complication of major conduction anesthesia and lumbar puncture for diagnostic or therapeutic reasons. It can interfere with maternalnewborn bonding and increase the length of hospitalization. Postdural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its incidence. We describe a case of pdph after unsuccessful epidural placement, followed by successful combined spinalepidural placement. The symptoms of are the result of decreased hydrostatic pressure in the subarachnoid space causing traction on the meninges. Postdural puncture headache definition of postdural. Is there a difference in postdural puncture headache after continuous spinal anesthesia with 28g microcatheters compared with punctures with 22g quincke or sprotte spinal needles. A presumptive diagnosis of an occult postdural puncture headache pdph was made, and the patient was treated with an intravenous iv infusion of 500 mg of caffeine sodium benzoate csb to. Cosyntropin for prophylaxis against postdural puncture. We present an interesting case report of a 49yearold female who presented with symptoms of postdural puncture headache following implantation of an intrathecal pain pump. A rational approach to the cause, prevention and treatment. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane.
Major neurologic complications associated with postdural. It enables drainage or collection of cerebrospinal fluid as well as administration of intrathecal medications. Postdural puncture headache is a distressing experience for the mother after delivery and also for a postoperative patient and can lead to significant morbidity. Posture and fluids for preventing postdural puncture headache. The postdural puncture headache is also known as occipital headache. During the postpartum period the obstetric patient with pdph is usually aware that her headache is iatrogenic and she may become depressed, resentful andor angry 24.
Postdural puncture headache pdph is believed to result from a loss of cerebrospinal fluid csf into the epidural space. Pathophysiology and management of postdural puncture headache. Clinical and laboratory research over the last 30 years has shown that use of smallgauge. Epidural blood patch for treatment of postdural puncture. Patients are always at risk of pdph post dural puncture headache when undergoing spinal anaesthesia, epidural. The patient was evaluated and felt to be a candidate for epidural blood patch, which she elected to proceed with. Csf analysis may aid in the diagnosis of meningitis, multiple sclerosis, intracranial hemorrhage, or meningeal carcinomatosis. This retrospective cohort study consisted of 1,003,803 women who received neuraxial anesthesia for childbirth in new york state hospitals between january 2005 and september 2014.
The incidence of postdural puncture headache was observed in 2. The incidence of inadvertent dural tap at attempted epidural placement in obstetric patients has been reported to be on the order of 0. Postdural puncture headache pdph is a positional headache ie, worse when the patient sits or stands that usually occurs society guideline links. Diagnosis of postdural puncture headache the postdural puncture headache can usually be diagnosed with a history of dural puncture and a presentation of severe postural headache. Guidelines for the diagnosis, treatment and prevention of post dural puncture headache diagnosis of headache headache is common in the postpartum period, affecting up to 40% of all parturients. Puerperal seizures associated with post dural puncture. Standardizing management of postdural puncture headache. The mechanism of postdural puncture headache, which is occasionally associated with hearing impairment, is likewise based on low csf pressure. Depending on the severity of the headache, the mother may be unable to adequately care for her newborn or herself for quite some time. Evidence based management of postdural puncture headache pdph. Open access full text article postdural puncture headache. This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter.
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