Effectiveness of Epidural Blood Patch in the Management of Post–Dural Puncture Headache

Safa-Tisseront, Valérie; Thormann, F; Malassiné, P.; Henry, Michel; Riou, Bruno; Coriat, Pierre; Seebacher, J

doi:10.1097/00000542-200108000-00012

Cited by 277 publications

(131 citation statements)

References 10 publications

Supporting

Mentioning

116

Contrasting

Unclassified

Order By: Relevance

“…17 It should be noted that the authors of this study took great care in the interpretation of their results, noting that their findings may simply reflect the more refractory nature of more severe headaches, which are more likely to be associated with larger gauge needles, more likely to be treated earlier and probably more likely to fail therapy, rather than evidence to suggest that one should delay EBP to improve the odds of success following large gauge punctures. We believe that this carefully noted observation applies to the results found in our study and would not recommend delaying EBP in symptomatic patients following DP except in the cases where air headache is possible or alternative causes of PDPHlike symptoms are being entertained (for example, sagittal sinus thrombosis in pre-eclampsia).…”

Section: Discussionmentioning

confidence: 83%

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

Angle

Tang

Thompson

et al. 2005

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : This retrospective cohort study examined hospital length of stay (LOS) and emergency room (ER) visits in parturients diagnosed with postdural puncture headache (PDPH) following recognized dural puncture (DP). All cases were managed expectantly. Outcomes were compared with matched controls with uneventful labour epidurals.M Me et th ho od ds s: : After Ethics Committee approval, the hospital perinatal database was used to identify healthy parturients with recognized DP during labour epidural placement from 1996-2001. Women developing PDPH after expectant management were matched with women with uneventful epidurals and no evidence of PDPH, as well as by parity, delivery mode and admission date. All women delivered term singletons. The primary outcome was LOS (hours) from delivery to discharge. Secondary outcomes included: number (#) nights in hospital, #ER visits for PDPH, epidural blood patch (EBP) timing (pre vs post discharge), EBP location (ward vs ER) and blood volumes used. R Re es su ul lt ts s: : 26 cases and 26 controls were identified. Precise discharge times were found for 23 cases and 23 controls. In cases, the LOS was increased by a mean of 17 ± 23.8 (SD) hours; [95% conficence interval (CI) = 8, 26; P = 0.0012] and # nights in hospital was increased by a mean of 0.62 ± 0.94 nights (95% CI, 0.26, 0.98, P = 0.0027). Nineteen cases (73% 19/26) received at least one EBP. Sixteen cases received at least one EBP prior to discharge with 38% (6/16) returning to ER for re-assessment/repeat EBP. Forty-four percent (4/9) of cases without an EBP prior to discharge returned to ER for further assessment/EBP. C Co on nc cl lu us si io on n: : PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.

show abstract

Section: Discussionmentioning

confidence: 83%

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

Angle

Tang

Thompson

et al. 2005

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…It is possible that these patients did not get enough information concerning treatment of headache or fear of the procedure kept them home. While drugs in treatment of PDPH are usually ineffective [19], epidural blood patching is safe, fast and effective in 90% of patients; and if repeated in patients showing a poor response the response rate rises up to 98% [20][21][22][23]. Despite that, epidural blood patch is underused in the treatment of patients with diagnostic lumbar puncture.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

et al. 2005

View full text Add to dashboard Cite

Post–lumbar puncture headache is a frequent clinical problem. Needle design is expected to reduce post–puncture headache. In this study, we compared two different lumbar puncture needle designs in diagnostic lumbar puncture and analysed post–dural puncture headache (PDPH) and social and economical harm associated with the diagnostic lumbar puncture procedure. This prospective, controlled study consisted of 80 consecutive adult patients requiring elective diagnostic lumbar puncture due to various neurological symptoms. Lumbar puncture was completed either with Spinocan ® 22 G sharp bevel needle or Whitacre ® 22G pencil point needle. Patients were asked about previous headache symptoms and pain provoked by puncture. One week after the lumbar puncture all patients were interviewed by telephone and occurrence and type of headache, headache intensity, medication and frequency of impairment in activities of daily living were asked. Need for epidural blood patch was also recorded. Thirty–three of 78 (42%) patients experienced headache after diagnostic lumbar puncture and in 26 (33%) the headache could be classified as PDPH. There were no statistically significant differences between needle types in the frequency of common headache, PDPH, puncture pain intensity, need for epidural blood patch or sick leave. Also, there were no other complications except local back pain or headache. In this study, the needle design did not affect the frequency of PDPH. Also, PDPH was common, occurring in 33% cases and caused a considerable amount of disturbance in daily activities. Seeking help for this condition was insufficient and only part of these PDPH patients were treated with epidural blood patch.

show abstract

“…Clinical experience has shown that epidural blood patch by preventing leakage through occluding the perforation is an effective therapy to treat a persistent post-spinal headache, with a success rate of more than 90% (3,4,5,34). However, as mentioned in the Introduction, a small CSF leakage is not compatible with a marked symptomatic influence on pain-sensitive regions of the brain, and especially not with the postural properties of the post-spinal headache, or the fact that the headache often disappears promptly after application of the blood patch.…”

Section: Discussionmentioning

confidence: 99%

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

Grände

2005

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture -a physiological approach.Grände, Per-Olof 619-626. DOI: 10.1111619-626. DOI: 10. /j.1399619-626. DOI: 10. -6576.2004 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Methods: Hydrostatic effects of distal opening of the dural sac towards the atmosphere are described and applied to the normal brain and the brain with disrupted BBB. Analogue analyses from an isolated skeletal muscle enclosed in a rigid shell were applied to the brain in an attempt to simulate and verify haemodynamic effects of distal opening of the spinal canal. Results Conclusion:The present study strongly suggest that post-spinal headache and brain stem compression and other LP-related effects are predictable following LP, without involving CSF leakage, and can be explained by hydrostatic effects triggered by distal opening of the normally closed dural space to the atmosphere.

show abstract

Effectiveness of Epidural Blood Patch in the Management of Post–Dural Puncture Headache

Abstract: Epidural blood patch is an effective treatment of severe post-dural puncture headache. Its effectiveness is decreased if dura mater puncture is caused by a large bore needle.

Cited by 277 publications

References 10 publications

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

Diagnostic lumbar puncture. Comparative study between 22–gauge pencil point and sharp bevel needle

Mechanisms behind postspinal headache and brain stem compression following lumbar dural puncture – a physiological approach

Contact Info

Product

Resources

About