A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients

Costa, Ana Célia; Satalich, James; Al-Bizri, Ehab; Shodhan, Shivam; Romeiser, Jamie; Adsumelli, Rishimani; Abola, Ramon; Steinberg, Ellen S.; Bennett‐Guerrero, Elliott

doi:10.1007/s12630-019-01486-6

Cited by 26 publications

(23 citation statements)

References 33 publications

(47 reference statements)

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“…The available data from this study are insufficient to draw conclusions on the effect of the new management protocol on this parameter. The incidence of discharge delay due to PDPH in patients diagnosed with PDPH was 38%, a much higher figure than that observed in the literature 17. This may be due to a small sample size and a more conservative treatment approach, as well as differing hospital practices.…”

Section: Discussionmentioning

confidence: 58%

Postdural puncture headache in the obstetric population: a new approach?

Xavier

Pinho

Silva

et al. 2020

Reg Anesth Pain Med

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Background and objectivesThe gold standard for the treatment of postdural puncture headache (PDPH) is the epidural blood patch (EBP). Regional techniques—sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and trigger point infiltration (TPI)—can also be used for the treatment of PDPH. Our objective was to evaluate the efficacy of these peripheral nerve blocks (PNBs) in the treatment of PDPH.MethodsA retrospective study was conducted including all patients with PDPH in the obstetrics department of our institution between April 2016 and December 2017. Data were retrieved from clinical records regarding anesthetic technique, symptoms, treatment, Numeric Pain Score (NPS) before and after treatment, among others.ResultsWe observed 50 cases of PDPH: 25 following spinal anesthesia, 19 following epidural block and 6 following combined spinal-epidural. Of these, seven were managed conservatively and one received EBP as first-line treatment. The remaining 42 patients received PNB as first-line treatment. Of these, 27 received only 1 course of PNB, while 15 received 2 courses. We observed a statistically significant improvement in the NPS after the first course of blocks (n=42), with a reduction of the median NPS by 6.0 (IQR 4.0–7.5; p<0.001). Improvement was also observed after the second course of blocks (n=15), with a reduction of the median NPS of 3.5 (IQR 1.5–5.0; p=0.02). Due to treatment failure, 9 of the 42 patients treated with PNB required EBP. None of these were cases following spinal anesthesia.ConclusionSPGB, GONB and TPI can be safe and effective options for treatment of PDPH, but do not completely eliminate the need for EBP. Prospective studies designed to identify factors associated with unsuccessful treatment are required.

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Section: Discussionmentioning

confidence: 58%

Postdural puncture headache in the obstetric population: a new approach?

Xavier

Pinho

Silva

et al. 2020

Reg Anesth Pain Med

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“…The occurrence of accidental dural puncture (ADP) during neuraxial anesthesia reported in the literature is relatively small -0,1 -1,5% [6,7] [4]. Costa et al [5] conducted a ten-year retrospective analysis of women, who received neuraxial anesthetic for labor and delivery. A total of 32655 women had neuraxial analgesia, only 298 (0,9%) were diagnosed with PDPH afterwards.…”

Section: Resultsmentioning

confidence: 99%

“…Usually, symptoms, such as vision and hearing impairment, photophobia, tinnitus, neck pain and nausea follow the headache [2,3] Normally, symptoms fade out within 10-14 days without any medical interventions [2]. However, a possibility of complications, such as chronic headaches, cerebral venous thrombosis, reversible cerebral vasoconstriction syndrome or subdural hematoma from traction in dural veins should be taken into consideration at any time [3,5].…”

Section: Resultsmentioning

confidence: 99%

“…As mentioned before, young pregnant women, especially the ones with low BMI, seem to be of the greatest risk for experiencing PDPH [7]. In addition, some authors suggest that multiparous and obese women might also be more likely to suffer PDPH [5]. History of PDPH, dehydration and history of migraines also influence the rates of PDPH [3,11,12].…”

Section: Risk Factorsmentioning

confidence: 99%

“…It is proven, that PDPH is a cause for longer hospitalization, maternal distress, increased drug consumption, additional medical interventions and impaired capability to nurture the baby [4]. Past research shows, that spinal anesthesia has played a major role in the decrease of maternal mortality rates compared to endotracheal anesthesia [5].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors, Clinical Manifestation and Prevention of Post-Dural Puncture Headache in the Obstetric Field

Kalinauskas¹,

Juotkutė²

2021

Health Sciences

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Introduction: Over the past decades, the number of women choosing to have epidural analgesia or undergoing spinal anesthesia during labor is steadily increasing. Consequently, a risk for complications is increasing. Post-dural puncture headache (PDPH) is considered one of the most common complication following accidental dural puncture (ADP). Sources and a method: A literature overview were conducted via search engine “PubMed (Medline)” and “Google Scholar”. Randomized controlled trials, meta – analysis, retrospective, prospective trials and systemic reviews on PDPH were selected. Aim of the review: To evaluate the most commonly described risk factors, clinical presentation and prevention of PDPH in the obstetric field. Results: The occurrence of ADP during neuraxial anesthesia reported in the literature is relatively small – 0,1 – 1,5%. PDPH is a potentially expected complication after any lumbar punction. It presents as a headache within five days of the puncture due to low cerebrospinal fluid pressure. The pain is often bilateral, located in the frontal or occipital areas. Symptoms, such as vision and hearing impairment, neck pain and nausea might follow. Usually, the symptoms fade out spontaneously within two weeks. Risk factors for PDPH are modifiable (technique of the injection and anesthesiologist’s skills) and non-modifiable (pregnancy, low body mass index (BMI), dehydration, history of PDPH). The goal of preventing PDPH is to identify and correct the risk factors associated with this condition. Main described means being equipment and experience, conservative measures, administration of epidural morphine, intravenous dexamethasone or cosyntropin, epidural blood patch and intrathecal catheter. Conclusions: 1. PDPH manifests as an orthostatic headache with or without ocular, neural, hearing and other symptoms. 2. Young pregnant women with low BMI are more likely to suffer from PDPH. 3. PDPH prevention consists of risk factor correction and proper medical techniques.

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Fundamentals of Emergencies in Obstetrics: Training and Simulation

Taşkın

Ofluoglu

2023

Practical Guide to Simulation in Delivery Room Emergencies

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A ten-year retrospective study of post-dural puncture headache in 32,655 obstetric patients

Cited by 26 publications

References 33 publications

Postdural puncture headache in the obstetric population: a new approach?

Postdural puncture headache in the obstetric population: a new approach?

Risk Factors, Clinical Manifestation and Prevention of Post-Dural Puncture Headache in the Obstetric Field

Fundamentals of Emergencies in Obstetrics: Training and Simulation

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