Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

Abstract

P Pu ur rp po os se e: : This retrospective cohort study examined hospital length of stay (LOS) and emergency room (ER) visits in parturients diagnosed with postdural puncture headache (PDPH) following recognized dural puncture (DP). All cases were managed expectantly. Outcomes were compared with matched controls with uneventful labour epidurals.M Me et th ho od ds s: : After Ethics Committee approval, the hospital perinatal database was used to identify healthy parturients with recognized DP during labour epidural placement from 1996-2001. Women developing PDPH after expectant management were matched with women with uneventful epidurals and no evidence of PDPH, as well as by parity, delivery mode and admission date. All women delivered term singletons. The primary outcome was LOS (hours) from delivery to discharge. Secondary outcomes included: number (#) nights in hospital, #ER visits for PDPH, epidural blood patch (EBP) timing (pre vs post discharge), EBP location (ward vs ER) and blood volumes used. R Re es su ul lt ts s: : 26 cases and 26 controls were identified. Precise discharge times were found for 23 cases and 23 controls. In cases, the LOS was increased by a mean of 17 ± 23.8 (SD) hours; [95% conficence interval (CI) = 8, 26; P = 0.0012] and # nights in hospital was increased by a mean of 0.62 ± 0.94 nights (95% CI, 0.26, 0.98, P = 0.0027). Nineteen cases (73% 19/26) received at least one EBP. Sixteen cases received at least one EBP prior to discharge with 38% (6/16) returning to ER for re-assessment/repeat EBP. Forty-four percent (4/9) of cases without an EBP prior to discharge returned to ER for further assessment/EBP. C Co on nc cl lu us si io on n: : PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.

Postdural puncture headache: evidence-based review for primary care

“…(4) The risk of PDPH is reduced by using a non-cutting and small-bore spinal needle. To balance the need for fast collection of CSF specimen with reducing the risk of PDPH, non-cutting needles not larger than 22 G appear optimal for diagnostic lumbar puncture 4 while non-cutting needles, 25 G or smaller, appear appropriate for spinal anaesthesia. …”

“…This procedure places patients in primary care at risk of PDPH -a complication that is very distressing to patients and which increases the costs of hospitalisation by prolonging the length of hospital stay. 4 In this article, we review the literature and provide primary care physicians with an evidence-based approach to the diagnosis and management of PDPH.…”

Postdural puncture headache and epidural blood patch use in elderly patients

“…Some studies suggest that prophylactic EBP may reduce PDPH symptoms or need of therapeutic EBPs [14], but without evidence of efficacy [15]. The timing of EBP in the present study, with a median of 96 hours, was longer than suggested [16,17] and reported [18]. However, the optimal timing has not been established, but there are studies that suggest that EBPs performed 48 hours or later after LP could be more efficacious than early EBP [2,4,9,19].…”

“…Less blood was used for EBP in OUH (median [minimum-maximum], 15 [7][8][9][10][11][12][13][14][15][16][17][18][19][20] mL) than in KUH (18 [15][16][17][18][19][20] mL) and in SCH (19 [18][19][20] mL; P = .014). The time from LP to EBP (P = .7), amount of blood used in EBP (P = .6), or duration of bed rest after EBP (P = .1) had no correlation with EBP efficacy.…”

Neurotoxicity of intrathecal 6% hydroxyethyl starch 130/0.4 injection in a rat model

“…It is a common iatrogenic cause of morbidity [1][2][3] that may have serious complications [4] and increase hospital length of stay and visits to the emergency department [5]. Epidural blood patch has become the gold standard treatment for PDPH [6,7].…”