Epidural injection of hydroxyethyl starch in the management of postdural puncture headache

Vassal, Olivia; Baud, Michel; Bonnin, M.; Vielle, E.; Bazin, JE; Chassard, D.

doi:10.1016/j.ijoa.2013.01.003

Cited by 26 publications

(17 citation statements)

References 16 publications

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“…Advocates of the epidural saline patch [32] include: 1) a single 30 ml bolus of epidural saline after development of headache; 2) 10-120 ml of saline injected as a bolus via the caudal epidural space; 3) 1.0-1.5 l of epidural Hartmann's solution over 24 h, starting on the first day after dural puncture; 4) 35 ml/h of epidural saline or Hartmann's solution for 24-48 h. However, large volume of saline should be avoided in case intraocular hemorrhages through a precipitous rise in intracranial pressure [186]. Kara et al reported a successful pediatric case with PDPH treated with epidural saline patch [187]. Epidural HES patch was also found effective in treating PDPH when patients contraindicated to EBP like bacteremia and leukemia [188,189].…”

Section: Alternative Maneuvers To Ebpmentioning

confidence: 99%

Post Dural Puncture Headache – We Can Prevent It

Wang

2014

Pain and Treatment

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Additional information is available at the end of the chapter http://dx.doi.org/10.5772/57408. Introduction "lthough modern anesthesiology has made great progress in the last decades, neuraxial anesthesia N" is still the keynote of regional blockade [ ]. N" is popular for its effectiveness in producing anesthesia for providing excellent intraoperative neuromuscular paralysis and in generating analgesia for relieving postoperative pain if continuously infused [ , ]. "s the N" techniques are used popularly in clinic, post dural puncture headache PDPH , a common iatrogenic complication resulted from post-spinal taps or accidental dural puncture "DP subsequent to epidural block, is frequently reported [ ] and becomes a challenge to health caregivers [ ]. "lthough the incidence of PDPH in research volunteers is ~ % [ ], in patients for whom the N" is for clinical purposes the prevalence of PDPH ranges from % to over % in different aged patients underwent either epidural or spinal or combined block [ ]. The leakage of cerebrospinal fluid CSF was considered as the major cause of PDPH [ ], whereas its real etiology is unknown. These procedure-and nonprocedure-related factors in combination determine the patterns of development of PDPH. Several procedures and methods were identified effective in treating and reducing the incidence of PDPH based on the knowledge of procedure-related factors, but whether could we prevent this morbid prior to its occurrence?Techniques developed based on how to reduce CSF leakage are classified into either preventive or therapeutic ones. "lthough the results from the differently designed studies were inconsistent [ ], one consensus on this topic reached is that we can prevent, at least in part, PDPH with currently available methods. Small size pencil point spinal needle [ , ], parallel bevel orientation [ ], liquid use for the loss of resistance LOR in epidural puncture [ ], and © 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.prophylactic epidural blood patch [ , ] are preventive considerations in reducing PDPH. Therapeutically, intrathecal saline injection [ , ], repeatable epidural blood patch [ ], and compensatory intrathecal catheterization for drug or fluid administration [ ] are means treating the on-going PDPH. "lthough the effectiveness of these methods is changing in different population at different ages under different clinical procedures, they are still promising for our patients."eside abovementioned procedure-related techniques, emerging pharmacological data support the use of analgesics. The most recent systematic review and meta-analysis [ ] revealed that morphine, cosyntropin, and aminophylline are effective for reducing the incidence of PDPH with any severity, but dexamethasone on the contrary increases the risk of PDPH. For fent...

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Section: Alternative Maneuvers To Ebpmentioning

confidence: 99%

Post Dural Puncture Headache – We Can Prevent It

Wang

2014

Pain and Treatment

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“…In theory, epidural filling with other materials should produce the same general effect. Indeed, this has been the case when treating PDPH in patients with EBP contraindications like leukemia and bacteremia [24][25][26]. A study showed that HES can be used for epidural volume extension in combination with spinal-epidural anesthesia for cesarean delivery [27].…”

Section: Discussionmentioning

confidence: 99%

Epidural filling with crystal-colloid solution prevented accidental dural- puncture-induced headache after cesarean section

J¹,

M²,

Yan³

et al. 2019

Preprint

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Background: Post dural puncture headache (PDPH) is a common anaesthetic complication caused by spinal puncture or accidental dural puncture during intraspinal anesthesia operation. There is no panacea, either preventive or therapeutic for PDPH. Methods: This study retrospectively collected and analyzed data on the clinical features and outcomes of 20 puerperants with accidental dural punctures. Seventeen individuals received crystal-colloid solution fillers and three did not. Results: The average epidural catheter retaining time was 35.97 hours; the average frequency of epidural filling was 2.65 times, with an average volume of 65.88 ml per fill. One patient developed tinnitus and three complained of head swelling during filling. The average bed-stay was 72.65 hours, with intravenous infusion volume of 2308.82 ml per day in the first three postoperative days. Two patients complained of slight dizziness and mitigation, and five felt weak. One individual had intermittent headaches and dizziness till the seventh postoperative day. Conclusions: Epidural injection of crystal-colloid solution combined with hydration is an effective preventive strategy for PDPH after cesarean section based on this observational study.

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“…Owing to its high molecular weight and viscosity, reabsorption of HES from the epidural space is slow, resulting in a long duration of action that may even allow time for closure of the dural puncture and termination of ongoing CSF leak [14]. Several case reports have been published suggesting the usefulness of epidurally administered HES for PDPH [10]. Moreover, a recent study involving 99 pregnant patients showed that HES can be used for epidural volume extension in combined spinal- Table 1 Objective assessment of activity before (day 8) and after (day 12) intrathecal injection in 19 rats measured using an infrared activity metre over 24 h. Values are mean (SD).…”

Section: Discussionmentioning

confidence: 99%

“…Other epidural and intrathecal injections such as saline, glue and colloid patches have been proposed, but their potential for neurological complications has not been formally assessed. Six percent hydroxyethyl starch 130/0.4 (HES) may represent a useful alternative in cases where autologous blood is contraindicated, and there have been case reports published describing its use in this clinical setting . There is, however, limited information about its potential for causing neurotoxicity following central neuraxial administration.…”

Section: Introductionmentioning

confidence: 99%

Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model

et al. 2015

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SummaryEpidural blood patch is the gold standard treatment for post-dural puncture headache, although hydroxyethyl starch may be a useful alternative to blood if the latter is contraindicated. The aim of this experimental study was to assess whether hydroxyethyl starch given via an indwelling intrathecal catheter resulted in clinical or histopathological changes suggestive of neurotoxicity. The study was conducted in rats that were randomly allocated to receive three 10-ll injections on consecutive days of either saline or hydroxyethyl starch administered via the intrathecal catheter. Eight rats were given injections of saline 0.9% and 11 were given 6% hydroxyethyl starch 130/0.4 derived from thin boiling waxy corn starch in 0.9% sodium chloride (Voluven â ). Daily clinical evaluation, activity measured by actimetry and neuropathological analysis of the spinal cord were subsequently performed to assess for signs of neurotoxicity. No clinical or actimetric changes were observed in either group following intrathecal saline or hydroxyethyl starch administration. Histopathological examination showed non-specific changes with no differences between the two groups. This experimental study in the rat suggests that repeated intrathecal injection of hydroxyethyl starch is not associated with neurotoxicity.

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Epidural injection of hydroxyethyl starch in the management of postdural puncture headache

Cited by 26 publications

References 16 publications

Post Dural Puncture Headache – We Can Prevent It

Post Dural Puncture Headache – We Can Prevent It

Epidural filling with crystal-colloid solution prevented accidental dural- puncture-induced headache after cesarean section

Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model

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