Headache after Attempted Epidural Block

Aida, Sumihisa; Taga, Kiichiro; Yamakura, Tomohiro; Endoh, Hiroshi; Shimoji, Koki

doi:10.1097/00000542-199801000-00014

Cited by 120 publications

(70 citation statements)

References 10 publications

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“…We excluded women with PDPH symptoms lasting less than the first 24 hr after DP since these self-limiting headaches were likely to represent headache related to air used as part of loss of resistance technique rather than cerebral spinal fluid leak. 16 Women with recognized DP (meeting study entry criteria) but no evidence of PDPH stayed in hospital around the same amount of time as women with uncomplicated epidurals [33 ± 16 (SD) vs 35 ± 13 (SD) hours respectively]. We found that patients who developed PDPH stayed in hospital longer (17 hr on average), that the added time usually involved an extra overnight stay, and that both women with treated and untreated headache prior to discharge had a high rate of return to the ER for assessment and treatment.…”

Section: Discussionmentioning

confidence: 99%

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

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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.

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Section: Discussionmentioning

confidence: 99%

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

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“…By definition,pneumocephalus is a subarachnoid collection of air within the cranium, which is most commonly seen following intracranial neurosurgical procedures [10].Although rare,reports of pneumocephalus complicating administration of epidural labor analgesia have been published [1,2,5,6,7,8,13,16].Aide et al reported a significantly higher incidence of inadvertent dural puncture and subsequent development of headache in patients whose epidural block placement was accomplished with the LORA technique as opposed to the LORS technique [1]. The authors speculated that the incidence of pneumocephalus-related headache was directly related to the amount of air injected into the subarachnoid space [1].…”

Section: Discussionmentioning

confidence: 99%

Post-dural puncture headache, intracranial air and obstetric anesthesia

Kuczkowski

2003

Anaesthesist

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Recently, a controversy has arisen as to whether air or saline should be recommended for the correct localization of the epidural space with the loss of resistance technique. I report a case of a previously healthy parturient who developed pneumocephalus and severe headache following the use of the loss of resistance to air (LORA) technique to identify the epidural space. This case report raises one more time the question about the safety of the LORA technique for labor analgesia.

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“…The first mechanism involves the leakage of cerebrospinal fluid while the second mechanism involves intrathecal injection of air. [14] Because severe headache may be associated with pneumocephalus, at least 2 ml air in the subarachnoid area is sufficient. [15] In our case, we used 5 ml ozone.…”

Section: Discussionmentioning

confidence: 99%

Severe headache following ozone therapy: pneumocephalus

Toman

Özdemir²,

Kiraz³

et al. 2016

Agri

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ÖzetPnömosefali kranial kavitede havanın olmasıdır. Pnömosefali epidural anestezi veya epidural steroid enjeksiyonu sırasında yanlışlıkla duranın delinmesi ile meydana gelebilir. Olgumuz 41 yaşında kadın hasta, lomber disk hernisi tanısı ile opere olmuş fakat şikayetleri devam ediyordu başarısız bel cerrahisi sendromu olduğu düşünüldü. Ameliyathanede sedoanaljezi yapılarak steril koşullarda ve skopi altında RACZ kateteri kaudal bölgeden epidural alana yerleştirildi. İlk olarak Madrid deklarasyonu doğrul-tusunda 20 ug/ml konsantrasyon ve 5 ml hacimde oksijen-ozon karışımı epidural aralığa verildi. Perkütan epidural nöroplasti için 5 dakika sonra 1500 Ünite hiyalüronidaz, %0.25 bupivakain + 80 mg triamsinolon kateterden yapıldı. İşlem sonrası hasta sedyeye alınır iken şiddetli baş ağrısı ve mide bulantısı şikayeti oldu. Hemen bilgisayarlı beyin tomografisi çekildi ve pnömosefali ile uyumlu hava, sağ lateral ventrikül frontal boynuzu, interhemisferik fissür ve süperior serebellar sisternada gözlendi. Hasta Trendelenburg pozisyonuna getirildi ve intravenöz sıvı verildi. Tedavi olarak analjezikler verildi ve yatak istirahati tavsiye edildi. Hasta ikinci gününde taburcu edildi. Baş ağrısı ve şikayetleri bir hafta içinde kayboldu. Bu yazıda başarısız bel cerrahisi sonrası, medikal ozon tedavisinin bir komplikasyonu olarak gelişen pnömosefaliyi literatür bilgileri ışığında tartışmaya çalıştık.Anahtar sözcükler: Epidural anestezi; başağrısı; ozon-oksijen teadvisi; pnömosefali. SummaryPneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in co...

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Headache after Attempted Epidural Block

Abstract: The use of air for loss-of-resistance testing during epidural block was associated with a higher incidence of PMPH, which might be attributable to subarachnoid air injection and CSF leakage.

Cited by 120 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

Post-dural puncture headache, intracranial air and obstetric anesthesia

Severe headache following ozone therapy: pneumocephalus

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