Morphology of antemortem dural puncture healing: an ex vivo sheep study

García‐Vitoria, Carles; García-Roselló, Mireia; Redondo, J. I.; Gutierrez-Bautista, A.; Andrés, José De; Boezaart, André P.; Vicente-Montaña, Ana; Reina, Miguel Ángel

doi:10.1136/rapm-2021-102867

Cited by 2 publications

(3 citation statements)

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“…10,11 Recent studies in sheep have shown us that the natural healing process of a dura-arachnoid lesion produced by a Tuohy needle is not linear but logarithmic with only 65% closure of the puncture holes at 7 days. 12 The resultant CSF leak then leads to downward traction on the brain, irritation of TA B L E 1 ICHD-3 Diagnostic Criteria: Headache attributed to low cerebrospinal fluid (CSF) pressure (section 7.2) (adapted from ICHD-3) the cranial nerves, and compensatory vasodilation of the cerebral vasculature causing pain and often other neurological sequelae. 13,14 A recent, retrospective, nested case-control study examining 154 patients showed the presentation to be typically positional (94%).…”

Section: Defining the He Adachementioning

confidence: 99%

“…Although the dural fibers tend to have sufficient “memory” to close the hole created by a spinal needle, the arachnoid has diminished capacity to do so, and thus it is the arachnoid damage, which may contribute primarily to PDPH characteristics 10,11 . Recent studies in sheep have shown us that the natural healing process of a dura‐arachnoid lesion produced by a Tuohy needle is not linear but logarithmic with only 65% closure of the puncture holes at 7 days 12 13,14 .…”

Section: Defining the Headachementioning

confidence: 99%

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Did she have an epidural? The long‐term consequences of postdural puncture headache and the role of unintended dural puncture

et al. 2021

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Objective This narrative literature review examines the long‐term impact of postdural puncture headache (PDPH) in postpartum women following an unintended dural puncture (UDP) with a large bore needle commonly used for epidural catheter placement. It seeks to bridge the knowledge gap for the neurologist as to the mounting body of obstetric anesthesia literature on the development of chronic headache after PDPH with this unique needle. Background Headache is the most common complication of dural puncture, and the risk is greatest in the parturient population. Preexisting risk factors for this population include youth and sex, and after UDP with a large bore needle, almost 70%–80% report a headache. Additionally, there appears to be a significant cohort who experience long‐term, persistent headache after UDP. Methods We performed a narrative review of literature using PubMed, searching terms that included long‐term follow‐up after UDP with a large bore needle in the postpartum population. Results In women who had UDP with a large bore needle used for epidural catheter placement at delivery, the rate of chronic debilitating headache is around 30% in the months following delivery and may persist for up to a year or longer. Conclusion Based on the existing literature, we have mounting evidence that UDP with the large bore needle used to place an epidural catheter should be understood as a high‐risk inciting event for the development of long‐term headaches not simply a high risk of acute PDPH. Additionally, consideration should be given to stratifying the etiology of PDPH, based on needle type, and recognizing the entity of chronic PDPH, thus allowing for improvements in research and diagnosis.

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Section: Defining the He Adachementioning

confidence: 99%

Section: Defining the Headachementioning

confidence: 99%

Did she have an epidural? The long‐term consequences of postdural puncture headache and the role of unintended dural puncture

et al. 2021

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“…Different mechanisms have been proposed to explain the presence of chronic headache following UDP. Chronic CSF leakage from an incomplete closure of dural lesion has been one of them 22 23. Hence, EBP would be expected to reduce the incidence of this complication 24.…”

Section: Discussionmentioning

confidence: 99%

Long-term complications of unintentional dural puncture during labor epidural analgesia: a case–control study

Downey

Carvalho

2022

Reg Anesth Pain Med

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IntroductionEpidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long-term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment.MethodsWe conducted a 1:1 case–control study with women who delivered at our institution from January 2015 to December 2019. Cases were women who received epidural analgesia and sustained an unintentional dural puncture, and controls were women who received epidural analgesia but did not sustain such complication. We matched cases and controls for date of delivery, age, and body mass index. All women completed an online survey with validated questionnaires for diagnosis of chronic headache and chronic back pain. We used dichotomic (yes/no) questions to look for the presence of chronic visual and auditory impairment.ResultsSixty-three case–control pairs were studied. Women who sustained a dural puncture during their epidural catheter insertion had a higher risk of developing chronic headache (14.3%, vs 4.8%, p=0.057, adjusted OR (AOR): 3.67 (95% CI 1.05 to 12.82)) and chronic back pain (39.7% vs 19.1%, p=0.009, AOR: 2.67 (95% CI 1.25 to 5.72)) than women who did not sustain a dural puncture. The incidence of chronic auditory impairment was also higher in the dural puncture group (14.3% vs 1.6%, p=0.01, AOR: 9.98 (95% CI 1.21 to 82.62)).ConclusionsAn unintentional dural puncture during epidural catheter insertion in parturients is associated with increased risk of chronic headache, back pain and auditory impairment.

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Morphology of antemortem dural puncture healing: an ex vivo sheep study

Cited by 2 publications

References 7 publications

Did she have an epidural? The long‐term consequences of postdural puncture headache and the role of unintended dural puncture

Did she have an epidural? The long‐term consequences of postdural puncture headache and the role of unintended dural puncture

Long-term complications of unintentional dural puncture during labor epidural analgesia: a case–control study

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