Postdural puncture headache in obstetric neuraxial anaesthesia: Current evidence and therapy

Dabas, Rajive; Lim, Ming; Sng, Ban Leong

doi:10.1016/j.tacc.2019.01.002

Cited by 3 publications

(5 citation statements)

References 88 publications

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“…Post dural puncture headache (PDPH) is a common problem following SA in parturients. [ 1 ] PDPH is not a life-threatening condition, but it can lead to severe limitation of daily activities. Moreover, it may cause catastrophic sequelae, such as subdural hematoma and seizures, when severe.…”

Section: Introductionmentioning

confidence: 99%

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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%

“…[ 2 ] With this background, emphasis on its prevention by optimising the controllable factors such as the anaesthetic technique, number of dural puncture attempts, needle size, and needle tip design, is important. [ 1 ]…”

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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“…In spite of developments in needle design and puncture techniques, PDPH remains the most common complication of neuraxial blockade due to the popularity of neuraxial blockade in obstetric anesthesia [ 7 ]. Pregnancy, female sex, and young age are all established risk factors for PDPH, which are frequently observed in obstetric patients.…”

Section: Introductionmentioning

confidence: 99%

“…Hydration and abdominal binder had insufficient evidence in the treatment of obstetric PDPH. Although there have been advances in the therapeutic epidural blood patch for PDPH treatment, it may cause chronic backache and a variety of neurological consequences [ 7 , 14 ]. Given the foregoing, obstetric anesthetists are eager to explore effective prophylactic medicines.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials

Zhao

Song

Liu

2023

BMC Pregnancy Childbirth

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Background Post-dural puncture headache (PDPH) is a major complication of neuraxial anesthesia. PDPH usually occurs after Caesarean section in obstetric patients. The efficacy of prophylactic pharmacological therapies remains controversial. Methods Seven pharmacological therapies (aminophylline (AMP), dexamethasone, gabapentin/pregabalin (GBP/PGB), hydrocortisone, magnesium, ondansetron (OND), and propofol (PPF)), were studied in this Bayesian network meta-analysis. The primary outcome was the cumulative incidence of PDPH within 7 days. Secondary outcomes included the incidence of PDPH at 24 and 48 h postoperatively, the severity of headache in PDPH patients (24, 48, and 72 h postoperatively), and postoperative nausea and vomiting (PONV). Results Twenty-two randomized controlled trials with 4,921 pregnant women (2,723 parturients received prophylactic pharmacological therapies) were included. The analyses demonstrated that PPF, OND, and AMP were efficient in decreasing the cumulative incidence of PDPH during the follow-up period compared to the placebo group (OR = 0.19, 95% CI: 0.05 to 0.70; OR = 0.37, 95% CI: 0.16 to 0.87; OR = 0.40, 95% CI: 0.18 to 0.84, respectively). PPF and OND had the lower incidence of PONV compared to the placebo group (OR = 0.07, 95% CI: 0.01 to 0.30; and OR = 0.12, 95% CI: 0.02 to 0.63). No significant difference in other outcomes was found among different therapies. Conclusions Based on available data, PPF, OND, and AMP may have better efficacy in decreasing the incidence of PDPH compared to the placebo group. No significant side effects were revealed. Better-designed studies are requested to verify these conclusions.

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“…The diminution in CSF pressure leads to traction on parietal dura and intracerebral structures; this traction causes PDPH. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

The comparison of post-dural puncture headache treatment with acetaminophen-caffeine capsule and intravenous mannitol infusion: A randomized single-blind clinical trial

Shahriari¹,

Nataj-Majd²,

Khooshideh³

et al. 2021

CJN

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Background: Post-dural puncture headache (PDPH) is a common problem after spinal anesthesia. Depending on the severity of PDPH, there are both invasive and non-invasive treatments. Caffeine has been used for the treatment of PDPH since 1949, but the administration of mannitol is a novel management to tackle PDPH. This study was conducted to compare the effectiveness of acetaminophen-caffeine and mannitol in the treatment of PDPH. Methods: We enrolled 80 patients with PDPH in the present clinical trial and observed them during 72 hours after cesarean section. Participants were randomly and equally allocated to two groups for treatment with intravenous (IV) mannitol or oral acetaminophen caffeine. The effects of treatment were evaluated using the visual analogue scale (VAS) questionnaire at hours of 1, 2, 3, 4, 6, 12, 18, 24, and 48. SPSS software was used. Results: Forty patients in each group completed the study. There was a significant reduction in the pain scores of the both groups after treatment, but the interaction between time and group demonstrated that mannitol administration was superior to acetaminophen-caffeine in pain reduction of the patients undergoing spinal anesthesia (P = 0.028). Patients’ satisfaction in the mannitol group was significantly higher than the caffeine group (P = 0.001). Conclusion: This study suggests that IV mannitol infusion affects faster and earlier for the treatment of PDPH than acetaminophen-caffeine capsule. Mannitol could be probably more effective for treatment of PDPH.

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Postdural puncture headache in obstetric neuraxial anaesthesia: Current evidence and therapy

Cited by 3 publications

References 88 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

Efficacy of pharmacological therapies for preventing post-dural puncture headaches in obstetric patients: a Bayesian network meta-analysis of randomized controlled trials

The comparison of post-dural puncture headache treatment with acetaminophen-caffeine capsule and intravenous mannitol infusion: A randomized single-blind clinical trial

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