Epidural blood patch cures postdural puncture headache in 90% of cases d. Original article, report by journal of evolution of medical and dental sciences. We report a case of persistent postdural puncture headache pdph in a patient despite two epidural blood patches ebps. Incidence of postdural puncture headache pdph and epidural blood patch.
We observed the ability of a triple prophylactic method epidural saline, morphine, and intravenous iv cosyntropin to prevent pdph and the need for. Accidental dural puncture and subsequent intrathecal. The procedure can be used to relieve post dural puncture headaches caused by lumbar puncture spinal tap. Review the epidemiology, etiology and diagnosis of postdural puncture headache pdph present risk factors for pdph. The onset of headache after lumbar puncture is usually within 2448 h after dural puncture, 1,5 but contrary to the above definition, it could be delayed by up to 12 days, 6 indicating that the time points in the definition are random. Post dural puncture headache pdph subsequently develops in approximately 80% of parturients1. Unintentional dural puncture and postdural puncture. Postdural puncture headache remains a prominent clinical concern to the present. An epidural blood patch may also help reduce other spinal fluid leak.
A comparative study to know the incidence of postdural puncture headache following subarachnoid block using 27 g quinckes and whitacre needlesa randomized clinical trial. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. This headache, called postdural puncture pdph, or lowpressure headache.
The incidence of accidental dural puncture varies based on practitioner experience, volume performed. Postdural puncture headache is a distressing experience for the mother after delivery and also for a postoperative patient and can lead to significant morbidity. Efficacy of a prophylactic epidural blood patch in preventing post. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture. Epidural blood patch the high success rate 6890% after. Effectiveness of epidural blood patch in the management of post. Accidental dural puncture is a known complication of epidural catheter placement. A low incidence 25% of pdph has been reported in morbidly obese parturients after 18g epidural anaesthesia2.
Assistant professor of anesthesiology, associate professor of anesthesiology, instructor of anesthesiology. The incidence of inadvertent dural puncture during the initiation of epidural analgesia. Accidental dural puncture is a recognized complication of epidural insertion. A second epidural blood patch was performed, resulting in partial subjective improvement, but incomplete resolution of her symptoms of headache, hearing loss and tinnitus. Efficacy of the epidural blood patch for the treatment of. The incidence of severe pdph is significantly higher following adp with a 16. Your healthcare provider will inject a sample of your own blood into your back, near the dural puncture site.
Postdural puncture headache management headache is not an uncommon complaint during the postpartum period. Postdural puncture headache pdph is the most common serious complication in obstetric anesthesia. We show the incidence of accidental dural puncture adp, pdph, epidural blood patch ebp and the associated morbidity following an. Review of the alternatives to epidural blood patch for. If symptoms are severe and persistent, an epidural blood patch is very effective at stopping the csf leak and resolving the headache 7. Epidural blood patch in postdural puncture headache. Health, general anesthetics research clinical trials analysis hypodermic needles usage hypodermic syringes.
Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. The incidence of postdural puncture headaches pdph as well as all reported headaches in subjects that received a prophylactic epidural blood patch pebp. Queen charlottes hospital london dural tap and pdph accidental dural puncture may occur with the epidural needle, in which case there is at least a 75% chance of a post dural puncture headache pdph developing. Inadvertent dural puncture is a risk of epidural anesthesia and occurs when the needle or catheter punctures the dura and arachnoid maters. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Queen charlottes hospital london dural tap and pdph.
It is thought to result from leakage of cerebrospinal fluid through the dura mater puncture hole and consecutively reduced fluid levels in the brain and spinal cord. By which mechanism does the epidural blood patch cure headache. Dural tap a headache following an epidural parents. The incidence of inadvertent dural puncture during the initiation of epidural analgesiaanesthesia in the obstetric population is between 0. Epidural morphine injections for prevention of post dural. Permanent hearing loss and tinnitus following epidural.
Although the headache may rarely present immediately after dural puncture, 7 its occurrence should alert. Objective postdural puncture headache pdph after an accidental dural puncture is a very common complication of epidural analgesiaanesthesia. Discuss epidural blood patch as treatment of pdph in children. Epidural blood patch introduction epidural catheter placement is commonly used to provide analgesia for labor and anesthesia for cesarean delivery. With a 17gauge needle, the incidence of post dural puncture headache pdph can be as high as 78% to 85% in these patients and is often severe and incapacitating 2. Post dural puncture headache in morbidly obese patients. This will include a discussion of the various oral or intravenous therapies and the nonbloodcontaining epidural injections. A small amount of the patients blood is injected into the epidural space near the site of.
Epidural blood patching for preventing and treating postdural puncture headache. At 7 days, only 3 of 21 conservatively treated patients had fully recovered no headache symptoms versus 16 of 19 patients treated with ebp p epidural blood patch in postdural puncture headache. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. We show the incidence of accidental dural puncture adp, pdph, epidural blood patch ebp and associated morbidity following a protocol established in an obstetric anesthesia department. The autologous epidural blood patch ebp was first shown to be effective in the treatment of these lowpressure headaches in the 1970s. There were no cases of severe pdph or epidural blood patch administration in the sp group. Inadvertent dural puncturewet tap and pdph management. The incidence of pdph following spinal anaesthesia is pdph postdural puncture headache pdph is a complication of puncture of the dura mater, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1. Accidental dural puncture adp is a recognised complication of epidural anaesthesia. Epidural blood patch technique, recovery, and success rate. She represented to the emergency department two days later with recurrence of a severe post dural puncture headache pdph and ongoing auditory symptoms.
In obstetric patients, conservative and pharmacological management of postdural puncture headache pdph is often ineffective. Epidural blood patch inpatient care what you need to know. Epidural blood patch in the treatment of post dural puncture headache. G tuohy needle can reduce the incidence of severe post.
A comparative study to know the incidence of postdural. The incidence of accidental dural puncture varies on the. Other studies have reported an increase incidence of failure rate or relapse of. The vertebral space where the ebp was performed is depicted in figure 2. Postdural puncture headache pdph is frequently associated with neck. Management of persistent pdph after repeated epidural. Consider the differences in etiology and treatment of pdph in adults as compared to children.
Controversy still exists over when to perform an ebp, how much blood to inject, and how to manage patients postebp. Headache is not an uncommon complaint during the postpartum period. Incidence and prediction of postdural puncture headache. Most have no problems at all with their epidural and once the numbness has worn off and sensation returns. Epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. The dura cannot be accidentally perforated with an epidural catheter, however the catheter can penetrate the. A spinal headache happens as a result of a hole being accidentally made in the membrane that separates the epidural and spinal space the dura. An epidural blood patch is a surgical procedure that uses autologous blood in order to close one or many holes in the dura mater of the spinal cord, usually as a result of a previous lumbar puncture. Evaluation of incidence of postdural puncture headache. Epidural blood patching ebp remains the gold standard treatment of pdph. Successful resolution of headache was achieved with a third ebp performed. A spinal headache, also known as a postdural puncture headache pdph, is the most common complication of epidural, spinal, or combined spinalepidural cse anesthesia.
An epidural blood patch is a procedure used to relieve a headache caused by spinal fluid leak after a dural puncture. Postdural puncture headache pdph is a frequent complication of lumbar puncture, performed for diagnostic or therapeutic purposes or accidentally, as a complication of epidural anesthesia. Last, the evidence behind interventional pain modalities and acupuncture will be examined. Effectiveness of epidural blood patch in the management of. Use of a triple prophylactic strategy to prevent post. Epidural blood patch in post dural puncture headache. Efficacy of a prophylactic epidural blood patch in. Postdural puncture headache and epidural blood patch in a.
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