Evaluation of Affecting Factors and The Effectiveness of Treatment in Cases With Post-Dural Puncture Headache Who Underwent Epidural Blood Patch

Abstract

Özet Amaç: Dural ponksiyon sonrası baş ağrısı (DPSB) olguları, katkıda bulunan faktörler, epidural kan yaması (EKY) tedavisi ve tedaviye yanıtları değerlendirildi. Bu çalışmada amacımız EKY uygulanan DPSB olgularını incelemektir. SummaryObjectives: We evaluated post dural puncture headache (PDPH) cases and the contributing factors and monitored the treatment response with epidural blood patch (EBP), and other therapies. Methods: In this retrospective study, 77 PDPH cases treated with EBP were included. Patients were evaluated in terms of age, gender, type of surgery, type and diameter of the needle used for dural puncture, number(s) of dural puncture, onset of punctural headache, any conservative therapies for PDPH, number(s) of EBP application, analgesia quality at the 10th minute and 2nd hour after EBP application, and radicular pain during procedure. Results: The mean age of 77 patients (46 female, 31 male) was 31.5 ± 11.3, and the most common surgery performed was cesarean section. More than one attempt was applied in 48 patients. In 37 cases, a 22G spinal needle was used, while a 25 G spinal needle was used in 20 cases. The mean duration of the headache was 3.1 ± 1.3 days for female patients and 4.6 ± 2.3 days for male patients (p=0.020). VAS significantly decreased and patient satisfaction significantly increased after the 10th minute in patients who had EBP (p=0.001). In only one case (2%), the second EBP was needed for pain relief. Transient radicular pain was observed in 17 cases (22.07%) at administration of EBP. Conclusion: In PDPH cases, EBP is an effective and relatively safe method, especially in obstetric patients. We reported that the PDPH symptoms presented earlier in female patients. A preference of a small diameter needle (less than 22 G) and avoidance of multiple attempts is important for spinal anesthesia.

Spontaneous intracranial hypotension following epidural anesthesia: a case report

“…1,11 However, many clinicians are reluctant to per-form this procedure doubting its effectiveness and safety. 1,11 However, many clinicians are reluctant to per-form this procedure doubting its effectiveness and safety.…”

“…To date, the epidural blood patch remains one of the most effective treatments for both PDPH and SIH in patients who have not responded to the initial trial of conservative management. 1,11 However, many clinicians are reluctant to per-form this procedure doubting its effectiveness and safety. The Association of Anaesthetists in Great Britain and Ireland states that if symptoms persist for 24-48 h or the headache is disabling, an epidural blood patch is recommended.…”

Postdural Puncture Headache: Incidence and Predisposing Factors in a University Hospital

“…The procedure continued while 15-20 ml of autologous blood was injected totally or while low back pain, neck pain, radicular pain continued spreading to the legs or worsening headache occurred. [8] After removing the cannula, patients routinely had bed rest in a supine position for 2 hours during which timeroutine vital monitoring continued. Vital monitoring continued for two hours after the procedure in a sitting position.…”

Lower incidence of postdural puncture headache using whitacre spinal needles after spinal anesthesia: A meta‐analysis

“…3,4 Epidural blood patch (EBP) is performed if the PDPH has persisted without sufficient response to the conservative therapy, which is named refractory cases. 5,6 Among the factors influencing the incidence of PDPH, regulating the size of the dural perforation holds significance for reducing the incidence of PDPH. 7 In general, the size of the dural perforation depends on the bevel orientation to the longitudinal dural fibers, the dural thickness at the puncture site, and the diameter of the spinal needles.…”