Intravenous Cosyntropin Versus Epidural Blood Patch for Treatment of Postdural Puncture Headache

Hanling, Steven; LaGrew, Joseph; Colmenar, Derrick H; Quiko, Albin S; Drastol, Carol A

doi:10.1093/pm/pnw014

Cited by 22 publications

(11 citation statements)

References 21 publications

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“…Despite the positive results of the aforementioned studies, a systematic review failed to demonstrate any prophylactic effects of epidural saline on PDPH incidence or the need for a blood patch (10). We propose that the triple prophylaxis potentiates the positive effects of individual methods by combining the analgesic effect of morphine, the pressure-equalizing effect of saline, and the increased production of cerebrospinal fluid and endorphin release induced by cosyntropin [16][17]. We may argue that even the small effect of epidural saline is maximized by the addition of the other two strategies.…”

Section: Discussionmentioning

confidence: 87%

Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study

Pérez

Sánchez

Rocuts

et al. 2020

Cureus

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Objective Post-dural puncture headache (PDPH) after an accidental dural puncture is a very common complication of epidural analgesia/anesthesia. We observed the ability of a triple prophylactic method (epidural saline, morphine, and intravenous (IV) cosyntropin) to prevent PDPH and the need for a blood patch. Methods We retrospectively evaluated the effect of the combination of epidural saline, IV cosyntropin, and epidural morphine in parturients who had an accidental dural puncture with regard to the PDPH rate and the need for an epidural blood patch. We report a case series of patients with accidental dural puncture who underwent triple prophylaxis and other methods. Results Thirty-one patients were included in the study. Fourteen cases received triple prophylaxis (45%). Three patients in this group developed PDPH (21%), with two of them requiring a blood patch (14%). Nine patients underwent preventive measures other than triple prophylaxis with a PDPH rate of 55% and one needing a blood patch (11%). Conservative management was used in eight patients with PDPH and blood patch rates of 100% and 62%, respectively. Conclusion The triple prophylactic regimen of epidural saline, IV cosyntropin, and epidural morphine used after accidental dural puncture exhibits great potential to reduce the incidence of PDPH and the need for blood patch in obstetric patients.

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Section: Discussionmentioning

confidence: 87%

Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study

Pérez

Sánchez

Rocuts

et al. 2020

Cureus

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“…The trial reported by Hakim found that administration of tetracosactide after accidental dural puncture in 90 parturients was associated with a significant reduction in the incidence of PDPH and requirement for epidural blood patch [39]. The efficacy of tetracosactide for the treatment of PDPH in 32 patients has been reported to be 56% (95% CI [33; 79%]) [40], and to be similar to that of epidural blood patch in a study that included 28 patients [41], although 4 of the 15 in the tetracosactide group also received a blood patch. However, a randomized trial that included 18 patients did not find any efficacy of tetracosactide in the treatment of PDPH, nor in the reduction of blood patch use [45].…”

Section: Introductionmentioning

confidence: 98%

“…Alternative treatments have recently been studied; they aim to be less invasive or to reduce headache intensity whilst waiting for the blood patch or the disappearance of PDPH. Several lines of evidence have suggested the effectiveness of adrenocorticotropic hormone (ACTH) in the management of PDPH [33][34][35][36][37][38][39][40][41]. Several mechanisms have been proposed to explain the effects of ACTH or its analogues on headaches.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the effectiveness and tolerance of tetracosactide in the treatment of post-dural puncture headaches (ESYBRECHE): a study protocol for a randomised controlled trial

Depaulis

Steer

Garessus

et al. 2020

Trials

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Background: Post-dural puncture headache (PDPH) is one of the most common complications of neuraxial anaesthesia. It limits patients' general activity and increases the length of hospital stays and the use of care. It is particularly disabling during the postpartum period, when mothers have to take care of their child. Epidural blood patch is the standard treatment for PDPH. However, it is an invasive procedure that may result in rare but serious complications. Recent evidence has suggested that adrenocorticotropic hormone (ACTH) is effective in the management of PDPH. The aim of this study is to assess the efficacy and safety of tetracosactide (Synacthen®), a synthetic analogue of ACTH, for PDPH treatment in patients who receive neuraxial anaesthesia during labour. Methods: This randomised, double-blind, placebo-controlled, parallel-arm trial, is performed in two French university hospitals. Eligible patients are those suffering from postpartum PDPH, who are randomised to receive either 1 mg of tetracosactide intravenously over 20 min or to 0.9% saline (placebo). The primary endpoint is the rate of epidural blood patch within a 15-day follow-up period. Headache duration, pain intensity, reduction of general activity, increase in length of hospital stay, adverse events, analgesic use (type and duration) and number of blood patches per patient in each group are recorded. Discussion: We expect a decrease in the use of epidural blood patch in those receiving tetracosactide, thus indicating a decrease in PDPH symptoms in these patients. This will define the therapeutic success of tetracosactide and the possibility to use this treatment as a non-invasive alternative to blood patch for PDPH treatment.

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“…Now there are several modalities treatment available for the treatment of post dural puncture puncture headache. Of these the most notable one is epidural blood patch [3] , which is considered to be gold standard for PDPH. But it effects are less than 100%.…”

Section: Introductionmentioning

confidence: 99%

Prospective randomized study of role of Inj. adrenocorticotropic hormone (Inj. Acth) in post dural puncture headache of the patients undergone lower segement cesaerian section

Umadevi¹,

Saravanan²

2020

Int. J. Med. Anesthesiology

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Evaluate the efficacy, hemodynamic effects and other side effects of inj. ACTH in the treatment of post dural puncture headache of the patients undergone. Material and MethodsPlace of study: Maruti Hospital Trichy, Time of study: 2016-to -2018 80 patients undergone lower segment cesarean section (LSCS) of ASA status I & II, aged between 20-40 years, who developed post spinal headache after spinal anaesthesia are included in our study They were assigned into any of the two groupson the randomized basis. Group a patients were assigned to receive INJ. ACTH 25 IU im and group p patients an injection of placebo 0.3ml Normal saline in two doses in 24 hour interval. Observation: It has been observed that the patients in both groups had similar demographic datas in respect to age, height, weight, distribution and also duration of the surgery and similar perioperative events. In Acth group within two hour of the injection, patients got significant relief and with the second dose of the injection complete relief occurred in majority of the patients at 72 hours in placebo group no such reduction in the headache score seen even after receiving tab. paracetamol. Conclusion: 86% of the patients in acth group have got complete relief from the headache at 72 hours compared to the 64% in the placebo group. There is some mild increase in the mean arterial pressure in the inj. Acth group and no change in pulse rate or respiratory rate between these two groups. There is virtually no side effects with the use of inj. Acth in post dural puncture headache.

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Intravenous Cosyntropin Versus Epidural Blood Patch for Treatment of Postdural Puncture Headache

Cited by 22 publications

References 21 publications

Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study

Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study

Evaluation of the effectiveness and tolerance of tetracosactide in the treatment of post-dural puncture headaches (ESYBRECHE): a study protocol for a randomised controlled trial

Prospective randomized study of role of Inj. adrenocorticotropic hormone (Inj. Acth) in post dural puncture headache of the patients undergone lower segement cesaerian section

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