Incidence and management of post-dural puncture headache following spinal anaesthesia and accidental dural puncture from a non-obstetric hospital: A retrospective analysis

Bakshi, Sumitra G; Gehdoo, Raghuveer Singh P

doi:10.4103/ija.ija_354_18

Cited by 18 publications

(18 citation statements)

References 25 publications

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“…Clinical research has shown that the use of smaller-gauge needles, particularly of the pencil-point design, are associated with a lower risk of PDPH than cutting-point needle tips. [ 3 4 ] However, the cost and lack of availability of the pencil-point needles make it difficult to be routinely used in parturients, especially in low-income countries. Neuraxial narcotics were found to reduce the incidence of PDPH after accidental dural puncture (ADP) during epidural anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

2020

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Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively ( P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group ( P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group. Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

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Section: Introductionmentioning

confidence: 99%

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

2020

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“…These findings spot light on a possible role for patients' age, BMI and vasomotor tone insatiability and development of PDPH and go in hand with Peralta et al [30] & Franz et al [31] who detected decreased PDPH incidence after Dural puncture in parturient with an increased BMI. Also, Bakshi & Gehdoo [32] and Özcan et al [33] detected a relation between incidence of PDPH and parturient age and found incidence was higher in age group of 20-40 years compared to older patients.…”

Section: Discussionmentioning

confidence: 98%

Single or Double Bilateral Greater Occipital Nerve Blocks to manage Headache after Spinal Obstetric Anesthesia

Salem

2019

JAICM

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Prolonged bed rest [9], hydration and caffeine intake [10] and analgesia are commonly used as prophylaxis and treatment for PDPH [11]; however, no substantial evidence supports routine Abstract Objectives: To evaluate outcome of bilateral Greater Occipital Nerve Block (GONB) for parturient had Cesarean Section (CS) under Spinal Anesthesia (SA) for management of post-Dural puncture headache (PDPH).Patients & Methods: PDPH severity was graded using modified Lybecker classification as mild, moderate or severe. Mild PDPH was managed conservatively at home. Patients had moderate, severe headache or persistent mild PDPH within 3-day undertook bilateral distal GONB (2% lidocaine and 0.5% bupivacaine; 1:1 mixture) at junction of medial third and lateral two-thirds of line joining External Occipital Protuberance (EOP) to mastoid process. Patients who had minimal or still had moderate improvement on distal block, received proximal GONB at 3-cm below and 1.5-cm lateral to EOP. Pain was scored using the numerical pain scale pre-and 3-hr post procedure, 1 and 4 weeks thereafter. Patients had minimal improvement on proximal block or recurred pain severity had Epidural Blood Patch (EBP).Results: 119 women (19.4%) developed PDPH; 87 had mild PDPH and received conservative management that resulted in 4-wk success rate of 56.4%. Patients with moderate and severe and mild PDPH that failed to respond to conservative management undertook distal GONB that showed primary, 1-wk and 4-wk success rates of 82.9%, 64.3% and 61.4%, respectively. 25 patients undertook proximal block for success rate of 78%. Conclusion:Bilateral GONB is simple, minimally invasive, safe and efficient therapeutic modality for moderate, severe and mild headache resistant to conservative treatment. Double, distal and proximal, block reduced the need for EBP down to 11.4%.

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“…Time to ambulation has not been found to be a factor affecting the incidence of PDPH. [ 25 ] A meta-analysis of the effectiveness of bed rest after dural puncture on PDPH concluded that PDPH prevalence did not differ between the groups assigned to 24 hours of bed rest or early ambulation. [ 26 ] A Cochrane review found that bed rest increased PDPH compared to early ambulation.…”

Section: Discussionmentioning

confidence: 99%

Effect of reinsertion of the spinal needle stylet after spinal anaesthesia procedure on post dural puncture headache in women undergoing caesarean delivery

et al. 2020

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Background and Aims: Post dural puncture headache (PDPH) following caesarean delivery (CD) is a cause for concern for anaesthesiologists. We aimed to study the effect of reinsertion of the stylet after spinal anaesthesia procedure, prior to spinal needle removal, on the incidence of PDPH in women undergoing CD. We also evaluated the risk factors associated with PDPH. Methods: In this randomised, double-blind study in a tertiary care hospital, 870 American Society of Anesthesiologists (ASA) II/III women undergoing CD under spinal anaesthesia were randomly divided into-GroupA (n = 435): stylet reinsertion before spinal needle removal and Group B (n = 435): spinal needle removal without stylet reinsertion. All patients were questioned for occurrence of PDPH at various time-points. Statistical calculations were done using Statistical Package for the Social Sciences (SPSS) 17 version program for Windows. Results: Sixty-two (7.1%) patients developed PDPH; 27 (6.2%) patients with stylet reinsertion and 35 (8.0%) patients in those with no stylet reinsertion; P = 0.389. The onset of headache was significantly delayed in patients with stylet reinsertion (16.2 ± 6.7 and 13.2 ± 4.3 h, respectively); P = 0.041 and they had greater severity of PDPH compared with those with no stylet reinsertion; P = 0.002. Factors significantly associated with PDPH were hypothyroidism, tea habituation, number of skin punctures and needle redirections, first pass success rate, occurrence of paraesthesia and contact with bone, intraoperative hypotension and time to ambulation. Conclusions: Reinsertion of the stylet before spinal needle removal did not influence the incidence of PDPH. The onset of PDPH was delayed and the severity of headache was greater in women in whom reinsertion of the stylet was done.

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Incidence and management of post-dural puncture headache following spinal anaesthesia and accidental dural puncture from a non-obstetric hospital: A retrospective analysis

Cited by 18 publications

References 25 publications

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial

Single or Double Bilateral Greater Occipital Nerve Blocks to manage Headache after Spinal Obstetric Anesthesia

Effect of reinsertion of the spinal needle stylet after spinal anaesthesia procedure on post dural puncture headache in women undergoing caesarean delivery

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