Peripheral Nerve Blocks for Postdural Puncture Headache: A New Solution for an Old Problem?

Giaccari, Luca Gregorio; Aurilio, Caterina; Coppolino, Francesco; Pace, Maria Caterina; Passavanti, Maria Beatrice; Pota, Vincenzo; Sansone, Pasquale

doi:10.21873/invivo.12597

Cited by 11 publications

(6 citation statements)

References 53 publications

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“…Seventh, fibrin glue should be reserved for management of PDPH refractory to EBP or when autologous blood injection is contraindicated (evidence grade: I; level of certainty: low). Important supporting references were Russell et al, Melchart et al, Sluder, Giaccari et al, and Chang et al…”

Section: Resultsmentioning

confidence: 95%

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Uppal,

Russell,

Sondekoppam

et al. 2023

JAMA Netw Open

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ImportancePostdural 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, and management of this condition is, however, currently lacking.ObjectiveTo fill the practice guidelines void and provide comprehensive information and patient-centric recommendations for preventing, diagnosing, and managing PDPH.Evidence ReviewWith input from committee members and stakeholders of 6 participating professional societies, 10 review questions that were deemed important for the prevention, diagnosis, and management of PDPH were developed. A literature search for each question was performed in MEDLINE on March 2, 2022. Additional relevant clinical trials, systematic reviews, and research studies published through March 2022 were also considered for practice guideline development and shared with collaborator groups. Each group submitted a structured narrative review along with recommendations that were rated according to the US Preventive Services Task Force grading of evidence. Collaborators were asked to vote anonymously on each recommendation using 2 rounds of a modified Delphi approach.FindingsAfter 2 rounds of electronic voting by a 21-member multidisciplinary collaborator team, 47 recommendations were generated to provide guidance on the risk factors for and the prevention, diagnosis, and management of PDPH, along with ratings for the strength and certainty of evidence. A 90% to 100% consensus was obtained for almost all recommendations. Several recommendations were rated as having moderate to low certainty. Opportunities for future research were identified.Conclusions and RelevanceResults of this consensus statement suggest that current approaches to the treatment and management of PDPH are not uniform due to the paucity of evidence. The practice guidelines, however, provide a framework for individual clinicians to assess PDPH risk, confirm the diagnosis, and adopt a systematic approach to its management.

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Section: Resultsmentioning

confidence: 95%

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Uppal,

Russell,

Sondekoppam

et al. 2023

JAMA Netw Open

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“…The most common local anesthetics used in RCTs include shortacting lidocaine (1%, 2%, occasionally 5%) and long-acting bupivacaine (0.25% or 0.5%), with open-label studies less commonly using medium-acting mepivacaine (2%) or long-acting ropivacaine (0.5% or 1%) or levobupivacaine (0.25%). 24,25 Some studies describe using mixtures of lidocaine and bupivacaine, and when lidocaine and bupivacaine are used together, the recommended ratio ranges from 1:1 to 1:3 (lidocaine: bupivacaine). 23 Per manufacturer guidance, lidocaine and bupivacaine dosing in a given session should be limited to a maximum of 300 and 175 mg, respectively.…”

Section: Nerve B Lock Anatomy and Techniquementioning

confidence: 99%

“…23 Per manufacturer guidance, lidocaine and bupivacaine dosing in a given session should be limited to a maximum of 300 and 175 mg, respectively. 26,27 There is little experience with the use of bupivacaine without epinephrine at doses above 175 mg. 24…”

Section: Nerve B Lock Anatomy and Techniquementioning

confidence: 99%

Narrative review of peripheral nerve blocks for the management of headache

et al. 2022

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Objective: To provide an overview of the current available literature on peripheral nerve blocks for the management of migraine and other headache disorders in adults.Background: Peripheral nerve blocks have been commonly performed in the headache practice for migraine, cluster headache, occipital neuralgia, and other headache disorders, despite a paucity of evidence supporting their use historically. In the past decade, there has been an effort to explore the efficacy and safety of peripheral nerve blocks for the management of headache, with the greatest interest centered around greater occipital blocks. Design:We performed a search in PubMed using key words including "occipital nerve blocks," "peripheral nerve blocks," "occipital nerve," "migraine," "cluster headache," and "neuralgia." We reviewed the randomized controlled trials (RCTs), observational studies, and case series, and summarized the anatomy, techniques, and the evidence for the use of peripheral nerve blocks in different headache disorders, with particular focus on available RCTs. Case reports were included for a detail review of adverse events.Results: Of 12 RCTs examining the use of greater occipital nerve blocks for migraine, all but one demonstrate efficacy with reduction in headache frequency, intensity, and/or duration compared to placebo. Studies have not demonstrated a difference in clinical outcomes with the use of corticosteroids for nerve blocks compared to blocks with local anesthetic in the treatment of migraine. There are two RCTs supporting the use of greater occipital blockade for cluster headache, both showing benefit of suboccipitally injected corticosteroid. One RCT suggests benefit of greater occipital nerve blocks for cervicogenic headache. Observational studies and case series/reports show that greater occipital nerve block may be effective in prolonged migraine aura, status migrainosus, post-dural puncture headache, and occipital neuralgia. Overall, peripheral nerve blocks are well tolerated. Serious side effects are rare but have been reported, including acute cerebellar syndrome and infection.Conclusions: Peripheral nerve blocks, especially occipital nerve blocks, are a viable treatment option for migraine and may be helpful in cluster headache as a transitional therapy or rescue therapy.

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“…However, there is poor evidence regarding the efficacy of these recommendations compared with immediate mobilization [7]. Therefore, additional clinical studies are needed to identify effective pharmacological options for PDPH prevention or treatment [8].…”

Section: Introductionmentioning

confidence: 99%

Post-dural puncture headache prevention and treatment with aminophylline or theophylline: a systematic review and meta-analysis

et al. 2023

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Background: Post-dural puncture headache (PDPH) is one of the most common complications in patients undergoing spinal anesthesia. The present systematic review and meta-analysis aimed to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH.Methods: Relevant studies were identified by searching the following electronic databases, without language restriction, until June 2020: Scopus, EMBASE, MEDLINE, Google Scholar, Web of Science, Cochrane Library-CENTRAL, and CINAHL Complete. Random effects models were used to calculate the standardized mean difference (SMD) and risk ratios (RRs) with 95% confidence intervals (95% CI) to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH, respectively. The Cochrane tool was used for the quality assessment of the included studies. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation method.Results: Of the 1,349 initial records, 15 met our eligibility criteria (6 studies on therapeutic and 9 on prophylactic effects). A significant reduction in the pain score was observed following aminophylline/theophylline treatment (SMD = –1.67; 95% CI, –2.28 to –1.05; P < 0.001, I2 = 84.7%; P < 0.001). Subgroup analysis revealed that the therapeutic effect was significantly higher when these agents were compared to placebo than when conventional therapies were used. The risk of PDPH after aminophylline administration was not significantly reduced (RR = 0.74; 95% CI, 0.42 to 1.31; P = 0.290).Conclusions: Theophylline and aminophylline have therapeutic, but not prophylactic, effects on PDPH.

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Peripheral Nerve Blocks for Postdural Puncture Headache: A New Solution for an Old Problem?

Cited by 11 publications

References 53 publications

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group

Narrative review of peripheral nerve blocks for the management of headache

Post-dural puncture headache prevention and treatment with aminophylline or theophylline: a systematic review and meta-analysis

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