Treatment of Postdural Puncture Headaches with Colloid Solutions: An Alternative to Epidural Blood Patch

Souron, Vincent; Hamza, J.

doi:10.1213/00000539-199911000-00071

Cited by 23 publications

(15 citation statements)

References 3 publications

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“…9 Souron et al found that the epidural colloid had a high success rate, no adverse effect. 10 We found that median effective dose of intrathecal hyperbaric bupivacaine 0.5% w/v with 25µg fentanyl was significantly lower in group 1 [4.0 mg (95% CI 4.40-5.60)] as compared with group 2 [7.0 mg (95% CI 6.93-7.61)]. Several mechanism were responsible for spinal block enhancement with epidural top up.…”

Section: Discussionmentioning

confidence: 79%

“…Safety and efficacy of colloid use in epidural space has been demonstrated in various previous studies. [8][9][10][11] Lander et al reported that the epidurally administered colloid (Dextran 40) had no neurotoxic effects as compared to epidural blood patch (EBP). 8 Another study demonstrated that injection of the epidural colloid increased the epidural pressure and immediately relieved headache.…”

Section: Discussionmentioning

confidence: 99%

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Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

et al. 2016

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INTRODUCTIONCombined spinal-epidural anesthesia (CSEA) is gaining popularity as preferred technique for caeserean sections and orthopaedic surgeries as it has rapid onset through spinal component and extension of aneasthesia and postoperative pain relief through epidural component while avoiding disadvantage of both. [1][2][3] Epidural volume extension (EVE) is a modification of CSEA in which fluid is injected in epidural space through epidural catheter after intrathecal spinal block. The epidural space with colloids, which compress the subarachnoid space, causes cephalic spread of intrathecal local anaesthetic to increase block height and speed of onset (Volume Effect). 1,4 In contrast EVE with local anaesthetic causes leaks from epidural space to subarachnoid puncture and also perineural or transdural spread of the extradural solution to enhance intensity and block duration besides volume effect. [5][6][7] In this study, we aimed to evaluate the efficacy of epidural volume extension (EVE) with colloid on dose requirement of intrathecal bupivacaine with fentanyl to ABSTRACT Background: Epidural volume extension (EVE) is a modification of combined-spinal epidural anaesthesia (CSEA) in which fluid is injected in epidural space after the intrathecal block. Fluid in epidural space compress subarachnoid space and causes cephalic spread of intrathecal drug to increase block height. Purpose of study is to determine efficacy of EVE on dose requirement of intrathecal bupivacaine when colloid was used for EVE. Methods: Sixty patients of ASA physical status I or II, scheduled for elective caesarean sections were recruited and randomized into two groups (30 each group). Group 1: CSEA in which spinal block is followed by 10 ml Colloid (HES 6%) in epidural space; Group 2: CSEA but no fluid in epidural space. Onset of sensory block and hemodynamic variables were measured at 5 min. intervals up to 40 minutes then at 10 min. intervals till end of surgery. Ineffective block was top-up by epidural 0.5% bupivacaine in incremental doses. Results: Median effective dose of intrathecal bupivacaine was significantly lower, 4.0 mg (95% CI 4.40-5.60) in group 1 versus 7.0 mg (95% CI 6.93-7.61) in group 2. Only 11 patients required ephedrine in group 1 versus 20 in group 2. Requirement of ephedrine was significantly lower 2.20 (±2.94) mg in group 1 versus 4.0 (±2.88) mg groups 2. Changes in haemodynamic variables from baseline were significantly lower in group 1 than those in group 2. Conclusions: EVE with colloid was effective in lowering dose requirement of spinal bupivacaine while patients hemodynamically were more stable.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

et al. 2016

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“…Epidural blood patch is thought to relieve the symptoms of PDPH by increasing the pressure within the intrathecal space [2,3,[5][6][7], and epidural HES injection should do likewise [14,29]. Owing to its high molecular weight and viscosity, reabsorption of HES from the epidural space is slow, resulting in a long duration of action that may even allow time for closure of the dural puncture and termination of ongoing CSF leak [14].…”

Section: Discussionmentioning

confidence: 99%

“…Owing to its high molecular weight and viscosity, reabsorption of HES from the epidural space is slow, resulting in a long duration of action that may even allow time for closure of the dural puncture and termination of ongoing CSF leak [14]. Several case reports have been published suggesting the usefulness of epidurally administered HES for PDPH [10].…”

Section: Discussionmentioning

confidence: 99%

Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model

et al. 2015

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SummaryEpidural blood patch is the gold standard treatment for post-dural puncture headache, although hydroxyethyl starch may be a useful alternative to blood if the latter is contraindicated. The aim of this experimental study was to assess whether hydroxyethyl starch given via an indwelling intrathecal catheter resulted in clinical or histopathological changes suggestive of neurotoxicity. The study was conducted in rats that were randomly allocated to receive three 10-ll injections on consecutive days of either saline or hydroxyethyl starch administered via the intrathecal catheter. Eight rats were given injections of saline 0.9% and 11 were given 6% hydroxyethyl starch 130/0.4 derived from thin boiling waxy corn starch in 0.9% sodium chloride (Voluven â ). Daily clinical evaluation, activity measured by actimetry and neuropathological analysis of the spinal cord were subsequently performed to assess for signs of neurotoxicity. No clinical or actimetric changes were observed in either group following intrathecal saline or hydroxyethyl starch administration. Histopathological examination showed non-specific changes with no differences between the two groups. This experimental study in the rat suggests that repeated intrathecal injection of hydroxyethyl starch is not associated with neurotoxicity.

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“…Alguns relatos e duas séries (56 e 17 pacientes) mostraram sucesso com esta abordagem. Foram utilizados de 20 a 30 ml de dextran 40 54,59 . Assim como a infusão peridural de solução fisiológica, a injeção de colóides aumenta imediatamente a pressão peridural e com isso promove alívio rápido da cefaléia.…”

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Tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção acidental da duramáter em paciente HIV positivo: relato de caso

Cruvinel¹,

Barbosa²,

Teixeira³

et al. 2002

Rev. Bras. Anestesiol.

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RESUMO Relato do Caso -Paciente masculino, 31 anos, 70 kg, estado f í s i c o A S A I I , p o r ta d o r d e H I V, pa r a t r a ta m e n t o d e condilomatose anal recidivada, com relato de cefaléia intensa e l i m i ta n t e d u r a n t e d u a s s e m a n a s a p ó s a n e s t e s i a subaracnóidea (agulha Quincke 25G S A I I , H I V p o s i t i v e , p r e s e n t e d f o r r e c u r r e n t a n a l

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Treatment of Postdural Puncture Headaches with Colloid Solutions: An Alternative to Epidural Blood Patch

Cited by 23 publications

References 3 publications

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

Effect of epidural volume extension with colloid on dose requirement for intrathecal spinal block: a double blind prospective study

Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model

Tampão peridural com dextran 40 na profilaxia da cefaléia pós-punção acidental da duramáter em paciente HIV positivo: relato de caso

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