Assessment: Prevention of post–lumbar puncture headaches

Abstract

Headache (HA) is a common sequel to lumbar puncture (LP), whether performed for diagnosis or anesthesia. [1][2][3][4][5][6] In their monograph summarizing the world literature through 1960, Tourtellotte et al.1 considered separately three principal patient populations: 1) patients undergoing diagnostic LPs (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA; 2) patients undergoing nonobstetric spinal anesthesia; and 3) patients undergoing obstetric spinal anesthesia. They reported several observations.1. The average frequency of post-LP HAs (PLPHA) in patients after diagnostic LP (excluding myelography, pneumoencephalography, and cisternal puncture), excluding also patients whose condition might reduce the reliability to report HA, was 32%. For nonobstetric spinal anesthesia, the average frequency was 13%. For obstetric spinal anesthesia, the average frequency was 18%. 2. In reports in which patients received special measures to prevent PLPHA, the average frequencies were 6% for diagnostic LPs, 5.5% for nonobstetric spinal anesthesia, and 6.2% for obstetric spinal anesthesia. The actual frequencies in individual series ranged from 0 to 18%. 3. The frequency of PLPHA was 36% in their own series of 105 normal individuals, 30% in 317 patients with diagnostic LPs, and 2% definite and 2% probable in 100 patients undergoing spinal anesthesia (but 30 patients with HAs of other types were excluded from the latter count).In analyzing risk factors for PLPHA, they concluded that the evidence, including their own prospective series, was convincing to consider younger age and female gender as definite risk factors. They attributed the difference of PLPHAs in obstetric and nonobstetric patients undergoing spinal anesthesia at least in part to these factors. They further considered the data fairly convincing that the smaller the needle size, the lower the frequency of PLPHA, but were unable to show this in their prospective series. They commented that the great variability of HA frequency for the same needle size between authors may reduce the reliability of this observation. With regard to all other risk factors, they concluded that the evidence was inconclusive. With regard to all preventive or therapeutic measures, they commented that proponents of a particular treatment, in general, found it to be beneficial; however, some of the reports were uncontrolled and some results could not be replicated by others. Today, we would consider the latter findings a result of publication bias-if one first tried a new approach to reducing the incidence of PLPHA, one would be less likely to publish a failure than a success.They commented on the different frequency of PLPHA in patients undergoing diagnostic LP compared with those undergoing spinal anesthesia, and considered the following factors in their series: age, gender, needle size, fasting, hydration, premedication and postoperative medication, minimal amount of trauma to the meninge...

A reinserção do estilete não afeta a incidência de cefaleia pós-punção dural (CPPD) após raquianestesia

“…In previous published studies Buettner (8.5%) 21 , Devicic (7.1%) 22 , Vallejo (8.7%) 23 , Evans (13%) 8 and Schmittner (16.9%) 24 have shown comparable PDPH results with 25G Quincke needles.…”

“…Gauge 25 Quincke needles were used for dural puncture performed with the patient in sitting position at the L3-4 interspace by a midline approach. We used a bevel direction parallel to the dural fi bers according to current American Academy of Neurology (AAN) guidelines 8,9 . Spinal anesthesia was induced by 0.5 % hyperbaric bupivacaine 2.5 mL injected into the cerebro-spinal fl uid (CSF).…”

Postdural puncture headache: Is epidural saline patch effective – A case report

“…3,10 PDPH usually develops within 24-48 hrs after dural tear but not immediately. [4][5][6] In our case, the cause of early development of PDPH may be due to sudden decrease in intrabdominal and CSF pressure after removal of large ovarian tumour. We infused 30 ml saline which relieved headache.…”

Perioperative Management of post dural puncture headache

“…Risk of developing PDPH depends on a number of factors and the incidence varies with the population studies needles & techniques have been used [9] [10]. The gauge of the lumbar puncture needle [11], size of the needle used & shape of the tip of the needle appear to be the most important individual factors which determines on the incidence [12]- [16].…”