Histopathologic Consequences of Epidural Blood Patch and Epidurally Administered Dextran 40

Lander, Christopher; Korbon, Gregg A.

doi:10.1097/00000542-198809010-00409

Cited by 15 publications

(8 citation statements)

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“…13,14 Moreover, since the epidural administration of autologous blood may result in radicular back pain, 15 and restricted spread of local anesthetics in future epidural blocks, 16 epidural dextran may be considered a more dependable therapy, especially when histopathological changes seen after EBP, such as fibroblastic activity and collagen formation, were not noted after epidural dextran. 17 Studies on the effect of dextran-40 injected in the subarachnoid space are not available, but the likelihood for blood (even autologous) entering the intrathecal space and producing arachnoiditis is feasible.…”

Section: Discussionmentioning

confidence: 99%

Persistent Post‐DuraI‐Puncture Headache Treated With Epidural Infusion of Dextran

Aldrete

1994

Headache

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A retrospective review was done on medical records of 13 patients with persistent post-dural-puncture headaches after one or more epidural blood patches. Headache occurred in nine patients with post-laminectomy syndrome after "wet taps" while performing epidural blocks. In two patients post-dural-puncture headache appeared after long term implanted intrathecal catheters were removed. In two other cases headache developed after spinal anesthesia. Treatment included bed rest, intravenous hydration and at least one epidural blood patch; three patients were given 60 milliliters of epidural saline, without success. Eight epidural catheters were inserted through the lumbar access and five through the caudal approach. Initially, a bolus of 20 milliliters of dextran-40 was given followed by an infusion of 3 mL/hr, until 12 hours after the head pain and any other related symptoms subsided. In all patients the headache disappeared within 20 hours after initiating therapy (9.55 mean hours, SD +/- 0.79). In five patients headache ceased in less than five hours. Nausea and photo-phobia subsided earlier. Patients with post-dural-puncture headache resistant to other treatments, including at least one epidural blood patch, were successfully treated by a bolus followed by continuous epidural infusion of dextran-40.

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Section: Discussionmentioning

confidence: 99%

Persistent Post‐DuraI‐Puncture Headache Treated With Epidural Infusion of Dextran

Aldrete

1994

Headache

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“…Histological studies have not demonstrated an in¯ammatory response following epidural Dextran 40 administration, however, in contrast to an autologous blood patch. 74 There is no reason to suppose that epidural saline is more likely to accelerate dural healing through a proin¯ammatory action than Dextran 40. Thus, there are no studies that are able to demonstrate either a sustained rise in CSF pressure or accelerated closure of the dural perforation after the administration of epidural saline.…”

Section: Epidural Salinementioning

confidence: 99%

Post-dural puncture headache: pathogenesis, prevention and treatment

Turnbull

Shepherd

2003

British Journal of Anaesthesia

721

652

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Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first-hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal fluid (CSF). In the last 50 yr, the development of fine-gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of post-dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post-dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation influence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post-dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post-dural puncture headache.

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“…[8][9][10][11] Lander et al reported that the epidurally administered colloid (Dextran 40) had no neurotoxic effects as compared to epidural blood patch (EBP). 8 Another study demonstrated that injection of the epidural colloid increased the epidural pressure and immediately relieved headache. Because of its viscosity, reabsorption of the colloid from the epidural space was delayed, leading to a greater and longer compression.…”

Section: Discussionmentioning

confidence: 99%

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

et al. 2016

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INTRODUCTIONCombined spinal-epidural anesthesia (CSEA) is gaining popularity as preferred technique for caeserean sections and orthopaedic surgeries as it has rapid onset through spinal component and extension of aneasthesia and postoperative pain relief through epidural component while avoiding disadvantage of both. [1][2][3] Epidural volume extension (EVE) is a modification of CSEA in which fluid is injected in epidural space through epidural catheter after intrathecal spinal block. The epidural space with colloids, which compress the subarachnoid space, causes cephalic spread of intrathecal local anaesthetic to increase block height and speed of onset (Volume Effect). 1,4 In contrast EVE with local anaesthetic causes leaks from epidural space to subarachnoid puncture and also perineural or transdural spread of the extradural solution to enhance intensity and block duration besides volume effect. [5][6][7] In this study, we aimed to evaluate the efficacy of epidural volume extension (EVE) with colloid on dose requirement of intrathecal bupivacaine with fentanyl to ABSTRACT Background: Epidural volume extension (EVE) is a modification of combined-spinal epidural anaesthesia (CSEA) in which fluid is injected in epidural space after the intrathecal block. Fluid in epidural space compress subarachnoid space and causes cephalic spread of intrathecal drug to increase block height. Purpose of study is to determine efficacy of EVE on dose requirement of intrathecal bupivacaine when colloid was used for EVE. Methods: Sixty patients of ASA physical status I or II, scheduled for elective caesarean sections were recruited and randomized into two groups (30 each group). Group 1: CSEA in which spinal block is followed by 10 ml Colloid (HES 6%) in epidural space; Group 2: CSEA but no fluid in epidural space. Onset of sensory block and hemodynamic variables were measured at 5 min. intervals up to 40 minutes then at 10 min. intervals till end of surgery. Ineffective block was top-up by epidural 0.5% bupivacaine in incremental doses. Results: Median effective dose of intrathecal bupivacaine was significantly lower, 4.0 mg (95% CI 4.40-5.60) in group 1 versus 7.0 mg (95% CI 6.93-7.61) in group 2. Only 11 patients required ephedrine in group 1 versus 20 in group 2. Requirement of ephedrine was significantly lower 2.20 (±2.94) mg in group 1 versus 4.0 (±2.88) mg groups 2. Changes in haemodynamic variables from baseline were significantly lower in group 1 than those in group 2. Conclusions: EVE with colloid was effective in lowering dose requirement of spinal bupivacaine while patients hemodynamically were more stable.

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Histopathologic Consequences of Epidural Blood Patch and Epidurally Administered Dextran 40

Cited by 15 publications

References 0 publications

Persistent Post‐DuraI‐Puncture Headache Treated With Epidural Infusion of Dextran

Persistent Post‐DuraI‐Puncture Headache Treated With Epidural Infusion of Dextran

Post-dural puncture headache: pathogenesis, prevention and treatment

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

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