Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch

Russell, Robin; Laxton, C.; Lucas, D. N.; Niewiarowski, J.; Scrutton, Mark; Stocks, Gary M.

doi:10.1016/j.ijoa.2018.12.005

Cited by 70 publications

(79 citation statements)

References 111 publications

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“…Although no report directly supports a relationship between headache and platelet indices after dural puncture, epidural blood patch and platelet-rich plasma-based methods involve platelets [19,36,37]; the healing properties of platelets may have contributed to the positive responses to these procedures obtained when applied in PDPH cases. Dodge et al evaluated the relationship between smoking and PDPH and found that PDPH was less common in their smoker group.…”

Section: Discussionmentioning

confidence: 99%

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

Uzundere

Kaçar

Kaya

2020

Pain Research and Management

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Objective. In this study, considering the importance of platelet function in inflammatory processes, we explored whether there are relationships of platelet indices with postdural puncture headache (PDPH) and pain developing after use of spinal needles and whether patient characteristics contribute to the development of PDPH. Methods. This prospective, observational study included 76 patients (Group 1) with PDPH and 93 patients (Group 2) without PDPH. The postoperative hemoglobin, hematocrit, platelet count (PC), and mean platelet volume (MPV) values were recorded, along with age, blood type, Rh factor, gravida, parity, and gestational age. In addition, the time of the onset of pain was recorded in patients who complained of a postspinal headache. Results. Hemoglobin and hematocrit values in Group 1 were significantly lower than in Group 2 (both, p=0.024). The PC of Group 1 was significantly higher than that of Group 2 (p<0.001), whereas the MPV was significantly lower (p<0.001). The area under the curve (AUC) values were significant for hemoglobin, hematocrit, PC, and MPV (p=0.022, p=0.024, p<0.001, and p<0.001, resp.). For MPV, the AUC value was 0.293, sensitivity was 1%, and specificity was 99%. The highest likelihood ratio (LR+) value was 1.22 at a cut-off value of 13.3 fL. For the PC, the AUC value was 0.666, the sensitivity was 9%, and the specificity was 99%, while the highest LR + value was 8.56 at a cut-off value of 352 × 109/L. There was no significant relationship between the parameters examined and the onset of pain. Conclusion. In this study, the PC was higher and MPV was lower in obstetric patients with PDPH compared with the control group. However, we also found that these two values cannot be used as markers of PDPH.

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Section: Discussionmentioning

confidence: 99%

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

Uzundere

Kaçar

Kaya

2020

Pain Research and Management

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“…Entgegen weit höherer Erfolgsraten nach Durchführung eines EBP in älteren Untersuchungen zeigen neuere Studien eine komplette und andauernde Beschwerdelinderung in ca. einem Drittel der untersuchten Fälle, während eine zumindest teilweise Besserung in 50-80 % erzielt wird [10]. Damit wird der EBP wei- [11,12].…”

Section: Hintergrundunclassified

Intranasale Lidocainvernebelung als neue und nichtinvasive Therapieoption des Postpunktionskopfschmerzes

et al. 2020

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Zusammenfassung Hintergrund Der Postpunktionskopfschmerz („postdural puncture headache“ [PDPH]) stellt eine ernsthafte anästhesiologische Komplikation geburtshilflich behandelter Patientinnen dar. Führen konservativ-medikamentöse Therapieversuche nicht zu einer Symptomlinderung, empfehlen aktuelle Leitlinien die frühzeitige Durchführung eines epiduralen Blut-Patch. Als potenzielle Alternative wird die transnasale Blockade des Ganglion sphenopalatinum mittels Lokalanästhetika diskutiert. Methode In dieser Falldarstellung wird erstmals von einer Modifikation dieser Technik unter Anwendung eines Medikamentenzerstäubers („mucosal atomization device“ [MAD]) zur Therapie eines PDPH bei zwei geburtshilflichen Patientinnen berichtet. Über dieses Verfahren existieren bislang keine Erfahrungen aus der geburtshilflichen Anästhesiologie. Ergebnisse Die erste Patientin (25-jährige Zweitgravida, BMI 54,7 kg/m2) zeigte am ersten Tag nach Sectio caesarea in Spinalanästhesie einen ausgeprägten PDPH mit starker Übelkeit und Erbrechen. Bei der zweiten Patientin (32-jährige Drittgravida, BMI 27,3 kg/m2) kam es 4 Tage nach Spontanpartus unter Periduralanästhesie zu einer PDPH-bedingten Wiederaufnahme. Während konservative Maßnahmen sowie Therapieversuche mit Nichtopioidanalgetika und Koffein keinen hinreichenden Behandlungserfolg erzielten, führte die intranasale Lidocainapplikation mittels MAD zu einer unmittelbaren und persistierenden Linderung der Beschwerden. Von beiden Patientinnen wurde die Lidocaingabe sehr gut vertragen; sie konnten am Folgetag aus dem Krankenhaus entlassen werden. Schlussfolgerung Die vorgestellte nichtinvasive und einfach durchzuführende Maßnahme stellt eine wertvolle Ergänzung bisheriger Therapieoptionen und eine potenzielle Alternative zum epiduralen Blutpatch bei geburtshilflichen Patientinnen mit PDPH dar.

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“…(6,11) Just as with any medical procedure the risk and benefits should be clearly explained to the patient, since the success rate is only around 70 %. (12) Emphasis should be made in the potential need repeat the procedure for total symptom relief.…”

Section: Epidural Blood Patchmentioning

confidence: 99%

“…Second, the increased pressure inside the spinal canal when transferred into the intracranial space, causes cerebral vasoconstriction, and hence offset the mechanisms causing the headache. (6,12) The perfect timing for an epidural blood patch has also been controversial. Some retrospective trials have suggested that the efficacy of the patch drops if it is done during the first 48 hours following the puncture, and patients should be warned about this.…”

Section: Epidural Blood Patchmentioning

confidence: 99%

New approaches and therapeutic options for post-dural puncture headache treatment

Caicedo-Salazar

Ríos-Medina

2020

Colomb. J. Anesthesiol.

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Post-dural puncture headache (PDPH) is a frequent complication in neuraxial approaches. It may result in disability, healthcare dissatisfaction and potentially serious complications. The traditional initial management includes general and analgesia measures with poor evidence. The treatment approach best supported by the literature is the epidural blood patch for which rates of up 70% improvement have been reported. Regional techniques have been recently described that may be helpful because they are less invasive than the epidural blood patch, under certain clinical circumstances. This article suggests an algorithm that uses such techniques for the management of this complication.

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Treatment of obstetric post-dural puncture headache. Part 2: epidural blood patch

Cited by 70 publications

References 111 publications

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

Can Platelet Count and Mean Platelet Volume be Used as Markers of Postdural Puncture Headache in Obstetric Patients?

Intranasale Lidocainvernebelung als neue und nichtinvasive Therapieoption des Postpunktionskopfschmerzes

New approaches and therapeutic options for post-dural puncture headache treatment

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