Sekar’s DISH10 (Deep Inspiration, Squeeze & Hold for 10 seconds) Maneuver- A Novel, Non-invasive and Cost-effective Treatment for Postdural Puncture Headache – A Comparative Cohort Study

Abstract

Introduction: Postdural puncture headache (PDPH) is one of the iatrogenic complications of the neuraxial blockade. Its incidence has steadily declined with advances in anesthesia techniques, improved knowledge of pathophysiology, and the implementation of preventable measures. However, it has the potential to cause signifi cant morbidity in affected individuals. This article introduces a new non-invasive and cost-effective treatment for PDPH termed DISH10 (Deep Inspiration, Squeeze & Hold for 10 seconds) maneuver. It also describes the essential steps involved in the DISH10 maneuver and discusses various biomechanics associated with these steps. We hypothesize that the DISH10 maneuver hastens spontaneous recovery by increasing intrathoracic and intraabdominal pressure and provides quick relief.Methods: This comparative cohort study includes 100 PDPH patients in three years, from January 2018 to March 2021. This study is divided into two groups. Group 1 included a prospective case series of 50 patients of PDPH treated with DISH10 maneuver. Group 2 included a retrospective cohort of 50 patients of PDPH treated with conventional conservative management with or without sphenopalatine ganglion block (SPGB). The demographics, type of neuraxial anesthesia, size/type of spinal needle, time to develop headache, and time to outcome were noted.Results: The incidence of PDPH was higher with 25G spinal needles (Quincke) in both the groups (82% in DISH10 and 74% in group 2) than with 27G spinal needles (Whitacre). The median of time to outcome (time to make patients symptom-free) with DISH10 maneuver was signifi cantly lower (7 hours) than the conservative group (48 hours). All 50 patients in Group 1 (case series) became symptoms-free and ready to discharge within 24 hours of commencement of the DISH10 maneuver. Conclusion:The DISH10 maneuver has shown better results than conventional conservative management with or without SPGB in terms of treatment duration, time to discharge, and total hospital stays, making the DISH10 maneuver a cost-effective option.