Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature

Song, Linlin; Zhou, Yin; Geng, Zhiyu

doi:10.12998/wjcc.v9.i8.1946

Cited by 2 publications

(3 citation statements)

References 31 publications

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“…[ 40 ] Two case series on the utility of epidural HES mostly for PDPH prophylaxis after obstetric ADP including 8 and 20 patients, respectively, reported that no serious adverse effects such as neurological deficits were detected. [ 22 , 41 ] Two recent rat studies indicated that single or repeated intrathecal injection of HES did not induce any clinical or histopathological evidence of long-term neuronal toxicity. [ 42 , 43 ] Although no adverse events potentially associated with epidural HES were reported, safety evidence should be sought further in this circumstance.…”

Section: Discussionmentioning

confidence: 99%

“…In a study evaluating epidural volume extension using colloids in combined spinal–epidural anesthesia for cesarean delivery, 33 pregnant patients received epidural 6% HES 200/0.5 and did not report any neurologic deficits postoperatively [40] . Two case series on the utility of epidural HES mostly for PDPH prophylaxis after obstetric ADP including 8 and 20 patients, respectively, reported that no serious adverse effects such as neurological deficits were detected [22,41] . Two recent rat studies indicated that single or repeated intrathecal injection of HES did not induce any clinical or histopathological evidence of long-term neuronal toxicity [42,43] .…”

Section: Discussionmentioning

confidence: 99%

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Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

Zhou

Geng

Song

et al. 2023

Chinese Medical Journal

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Background: No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. Methods: Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. Results: A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). Conclusions: The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

Zhou

Geng

Song

et al. 2023

Chinese Medical Journal

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“…178 In a retrospective case series, Song et al assessed the effectiveness of injecting HES 6% solution 15 mL into the epidural space to prevent PDPH after an inadvertent dural puncture. 179 The authors concluded that this was highly effective in preventing the occurrence of PDPH. However, a limitation was that the injection of HES was performed 24 hours after using an epidural catheter to provide analgesia; therefore, it is unclear which intervention was effective.…”

Section: Original Researchmentioning

confidence: 99%

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Uppal,

Russell,

Sondekoppam

et al. 2023

Reg Anesth Pain Med

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IntroductionPostdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH.MethodsBased on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach.ResultsBased on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence.ConclusionsThese clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients’ interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.

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Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature

Cited by 2 publications

References 31 publications

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

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