Post Dural Puncture Headache – We Can Prevent It

Abstract

Additional information is available at the end of the chapter http://dx.doi.org/10.5772/57408. Introduction "lthough modern anesthesiology has made great progress in the last decades, neuraxial anesthesia N" is still the keynote of regional blockade [ ]. N" is popular for its effectiveness in producing anesthesia for providing excellent intraoperative neuromuscular paralysis and in generating analgesia for relieving postoperative pain if continuously infused [ , ]. "s the N" techniques are used popularly in clinic, post dural puncture headache PDPH , a common iatrogenic complication resulted from post-spinal taps or accidental dural puncture "DP subsequent to epidural block, is frequently reported [ ] and becomes a challenge to health caregivers [ ]. "lthough the incidence of PDPH in research volunteers is ~ % [ ], in patients for whom the N" is for clinical purposes the prevalence of PDPH ranges from % to over % in different aged patients underwent either epidural or spinal or combined block [ ]. The leakage of cerebrospinal fluid CSF was considered as the major cause of PDPH [ ], whereas its real etiology is unknown. These procedure-and nonprocedure-related factors in combination determine the patterns of development of PDPH. Several procedures and methods were identified effective in treating and reducing the incidence of PDPH based on the knowledge of procedure-related factors, but whether could we prevent this morbid prior to its occurrence?Techniques developed based on how to reduce CSF leakage are classified into either preventive or therapeutic ones. "lthough the results from the differently designed studies were inconsistent [ ], one consensus on this topic reached is that we can prevent, at least in part, PDPH with currently available methods. Small size pencil point spinal needle [ , ], parallel bevel orientation [ ], liquid use for the loss of resistance LOR in epidural puncture [ ], and © 2015 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.prophylactic epidural blood patch [ , ] are preventive considerations in reducing PDPH. Therapeutically, intrathecal saline injection [ , ], repeatable epidural blood patch [ ], and compensatory intrathecal catheterization for drug or fluid administration [ ] are means treating the on-going PDPH. "lthough the effectiveness of these methods is changing in different population at different ages under different clinical procedures, they are still promising for our patients."eside abovementioned procedure-related techniques, emerging pharmacological data support the use of analgesics. The most recent systematic review and meta-analysis [ ] revealed that morphine, cosyntropin, and aminophylline are effective for reducing the incidence of PDPH with any severity, but dexamethasone on the contrary increases the risk of PDPH. For fent...

Sekar’s DISH10 (Deep Inspiration, Squeeze & Hold for 10 seconds) Maneuver- A Novel, Non-invasive and Cost-effective Treatment for Postdural Puncture Headache – A Comparative Cohort Study

“…Comparing this group with the retrospective cohort (Group 2) evinced reduced time to outcome (treatment duration), making patients ready to discharge. Other fi ndings like the occurrence of PDPH commonly in the younger population (median age in years of Group 1 is 32.5, and Group 2 is 35) and its association with large-bore needles (78% with 25 G Quincke-type and 22% with 27 G Whitacre-type) are consistent with available literature of PDPH [7][8][9][10][11][12][13].…”

Epidural blood patch for an eight-months’ history of post-dural puncture headache: case report

“…18,19 However, gender does not seem to be a factor if the age differences other co-founding factors such as pregnancy are corrected for. 1,5,20 Other risk factors for PDPH include low body mass index (BMI), taller height of patient, sitting position during dural puncture, bevel orientation, non-smoking, lower systolic blood pressures and perioperative use of dexamethasone. 5 The Figure 1.…”

“…1,5,20 Other risk factors for PDPH include low body mass index (BMI), taller height of patient, sitting position during dural puncture, bevel orientation, non-smoking, lower systolic blood pressures and perioperative use of dexamethasone. 5 The Figure 1. Below illustrates the incidence of PDPH depending on the type of needles used.…”

“…Headaches due to other causes do not alter intensity during these maneuvers. 5,23 Standard EBP procedure was performed on our patient eight month after the spinal anaesthesia. Patient reported no headaches at 2 hours post EBP and the lower back "heaviness" reported after injections of 15cc of blood resolved.…”

“…[1][2][3][4] The epidural blood patch (EBP) is the most effective of the therapeutic strategies and has been recommended both as a diagnostic and treatment modality for persistent headache after dural puncture. 5…”