The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. Patients are always at risk of pdph post dural puncture headache when undergoing spinal anaesthesia, epidural. August bier noted this adverse effect in 1898 in the first patient to undergo successful spinal anesthesia, a 34yearold laborer undergoing resection of an ulceration of the foot. However, use of the word postdural has been criticized as confusing and probably inaccurate, resulting in the proposal of an. The incidence of postdural puncture headache was observed in 2. Guidelines for the management of post dural puncture headache by philip anderson 1 introduction 1. Post dural puncture headache hugh platt slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Postdural puncture headache is a distressing experience for the mother after delivery and also for a postoperative patient and can lead to significant morbidity. Exacerbation of the headache by adoption of the upright posture, and improvement of the pain by lying down is the sine qua non of postdural puncture headache pdph. A lumbar puncture is a diagnostic and therapeutic procedure in which a spinal needle is passed into the subarachnoid space. Postdural puncture headache pdph is one of the most common complications encountered by physicians following spinal anesthesia or lumbar puncture. Guidelines for the diagnosis, treatment and prevention of. If you continue browsing the site, you agree to the use of cookies on this website. Epidural blood patch cures postdural puncture headache in 90% of cases d.
Study evaluating sphenopalatine ganglion block spgb for treatment of postdural puncture headache pdph pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. Postdural puncture headache core concepts anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. Pathophysiology and management of postdural puncture headache. The patient was evaluated and felt to be a candidate for epidural blood patch, which she elected to proceed with.
Her history was complicated by previous multilevel spinal fusion with hardware. Postdural puncture headache pdph is a common complication after inadvertent dural puncture. An updated report 2016 american academy of neurology aan. The resulting loss in csf pressure leads to traction on the meninges and a severe headache, which is often positional and accompanied by.
Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. Evaluation of post dural puncture headache using various sizes of. This terminology has been officially adopted in the international classification of headache disorders and is used in this chapter. The incidence of post dural puncture headache following. It enables drainage or collection of cerebrospinal fluid as well as administration of intrathecal medications.
Postdural puncture headache management headache is not an uncommon complaint during the postpartum period. In this case, an epidural blood patch was performed using epidural catheter under fluoroscopic guidance to target the site of csf leak and to avoid damaging the intrathecal catheter. This study tested the hypothesis that pdph in obstetric patients is associated with significantly increased postpartum risks of major neurologic and other maternal complications. Postdural puncture headache in the obstetric patient. Postdural puncture headache pdph is believed to result from a loss of cerebrospinal fluid csf into the epidural space. During the postpartum period the obstetric patient with pdph is usually aware that her headache is iatrogenic and she may become depressed, resentful andor angry 24. There is controversy over whether age and gender are independent risk factors for the development of postdural puncture headache. Articles published from january 1980 to april 1992 were obtained through a search of medline and index medicus.
An epidural blood patch was performed using 15 ml of autologous blood, which relieved her headache. Postdural puncture headache pdph is an important iatrogenic cause of patient morbidity in modern anesthesia, pain management after attempted epidural blocks and after spinal taps. Kokki h, salonvaara m, herrgard e, onen p 1999 postdural puncture headache is not an agerelated symptom in children. The following day the patient began to complain of a severe frontal headache with associated neck and back pain, characteristic of a post dural puncture headache pdph.
Postdural puncture subdural hematoma or postdural puncture. Subsequent to this procedure, 042% of the patients develop headache over the frontal and occipital areas radiating to the neck and shoulders. Puerperal seizures associated with post dural puncture. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. Guidelines for the management of post dural puncture. This headache, called postdural puncture pdph, or lowpressure headache.
Is there a difference in postdural puncture headache after continuous spinal anesthesia with 28g microcatheters compared with punctures with 22g quincke or sprotte spinal needles. Cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The most common adverse event associated with lp is postdural puncture headache pdph, which can be incapacitating and cause significant morbidity. Included studies compared atraumatic needles with conventional needles for lumbar puncture. Postdural puncture headache is the most frequent complication of major conduction anesthesia and lumbar puncture for diagnostic or therapeutic reasons. The symptoms of are the result of decreased hydrostatic pressure in the subarachnoid space causing traction on the meninges. Cosyntropin for prophylaxis against postdural puncture. Postdural puncture headache pdph is an unfavorable situation seen in considerable number of patients even though atraumatic and small needle reduces its incidence.
The onset is usually within the first three days of the dural puncture 90% of pa tients and 66% starts in the first 48 hours 1 11 12. By dr saravanavel sagadai topic advisor, nhs evidence surgery, anaesthesia, perioperative and critical care and consultant in anaesthesia, james paget university hospitals nhs foundation trust and dr gokulnath rajendran st3 in anaesthesia, ipswich hospital, ipswich. Depending on the severity of the headache, the mother may be unable to adequately care for her newborn or herself for quite some time. A postdural puncture headache pdph occurs after intentional in the case of spinal anesthesia or accidental in the case of epidural anesthesia puncture of the dura mater. In this retrospective study, the question was raised and answered whether the rate of postdural. Full text is there a difference in postdural puncture.
Postdural puncture headache in complex regional pain. The postdural puncture headache is also known as occipital headache. A rational approach to the cause, prevention and treatment. Diagnosis of postdural puncture headache the postdural puncture headache can usually be diagnosed with a history of dural puncture and a presentation of severe postural headache. St georges hospital london guidelines for the diagnosis, treatment and prevention of post dural puncture headache diagnosis of headache headache is common in the postpartum period, affecting up to 40% of all parturients. Open access full text article postdural puncture headache. We present an interesting case report of a 49yearold female who presented with symptoms of postdural puncture headache following implantation of an intrathecal pain pump. Postdural puncture headache pdph is a benign condition and the most frequent complication of spinal anesthesia. Postdural puncture headache pdph is a positional headache ie, worse when the patient sits or stands that usually occurs society guideline links. Guidelines for the diagnosis, treatment and prevention of post dural puncture headache diagnosis of headache headache is common in the postpartum period, affecting up to 40% of all parturients. Headache following dural puncture is a typical complication of neuraxial analgesia and can impair the ability to perform activities of daily living up to incapacitation. Spinal anesthesia is known to have numerous benefits, including reductions in nausea and opioid consumption. It can interfere with maternalnewborn bonding and increase the length of hospitalization. Postpartum headache is a common symptom with multiple causes.
Study evaluating sphenopalatine ganglion block spgb for. State of current practice there continues to be a lack of consensus among anesthesiologists regarding the management of postdural puncture headache24. The incidence of inadvertent dural tap at attempted epidural placement in obstetric patients has been reported to be on the order of 0. Evidence based management of postdural puncture headache. Associate professor and director of obstetric anesthesiology. Unintentional dural puncture and postdural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and.
The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. This retrospective cohort study consisted of 1,003,803 women who received neuraxial anesthesia for childbirth in new york state hospitals between january 2005 and september 2014. Evidence based management of postdural puncture headache pdph. Article pdf available in korean journal of anesthesiology 702. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates.
Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. We describe a case of pdph after unsuccessful epidural placement, followed by successful combined spinalepidural placement. Major neurologic complications associated with postdural. The literature specifically examining this complication in adolescents is scarce. Subdural hematoma and postdural puncture headache from.
Postdural puncture headache pdph is a potential expected complication of a lumbar puncture, with symptoms related to traction on painsensitive structures from low cerebrospinal fluid csf pressure intracranial hypotension following a leak of csf at the puncture site. Cathie lm sudlow, department of clinical neurosciences, university of edinburgh, western general hospital. Postdural puncture headache pdph complication of neuraxial technique incidence low with smaller diameter, noncutting, pencilpoint spinal needles. This headache, called postdural puncture pdph, or lowpressure headache lph, is postural and usually self limiting, appearing on the. The mechanism of postdural puncture headache, which is occasionally associated with hearing impairment, is likewise based on low csf pressure. Studies that did not include dural puncture were excluded. Clinical and laboratory research over the last 30 years has shown that use of smallgauge. Cosyntropin also reduced the need for epidural blood patch from 30% to 11%. Apfel cc, prevention of postdural puncture headache after accidental drual puncture. Use of intravenous cosyntropin in the treatment of.
Outcomes included postdural puncture headache, any headache, need for iv fluid or controlled analgesia, need for epidural blood patch, success on first lumbar puncture attempt, nerve root. Postduralpuncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Lumbar puncture knowledge for medical students and. Postdural puncture headache pdph can occur as a result of diagnostic lumbar puncture, spinal anaesthesia, and accidental dural puncture during epidural anaesthesia. Standardizing management of postdural puncture headache. A presumptive diagnosis of an occult postdural puncture headache pdph was made, and the patient was treated with an intravenous iv infusion of 500 mg of caffeine sodium benzoate csb to.
The use of thin, atraumatic needles and special puncture techniques e. Postdural puncture headaches revolutionary treatment for. Inadvertent dural puncture during epidural anesthesia is a more common cause of pdph than spinal anesthesia because of the use of small. Posture and fluids for preventing postdural puncture headache. Postdural puncture headache pdph was perhaps the first recognized complication of regional anesthesia. Patients with chronic headaches were reported to be more likely. Postdural puncture headache definition of postdural. It is exacerbated by movement and sitting or standing. Risk of postdural puncture headache in adolescents and. Postdural puncture headache pdph is a complication of spinal anesthesia and unintentional dural puncture during attempted epidural anesthesia.
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