Postdural puncture headache and the development of the epidural blood patch

The occurrence of post dural puncture headache after epidural. Epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Epidural blood patch for an eightmonths history of postdural. The international headache society ihs has defined a. Epidural blood patch was performed after a median delay of 4 days range, 153 days after dural puncture. Kara i, ciftci i, apiliogullari s, arun o, duman a, celik jb. Epidural blood patch ebp is considered the definitive treatment of pdph with a reported success rate of 85%. Epidural patching medical clinical policy bulletins aetna. The epidural blood patch ebp is regarded by many as the goldstandard treatment of postdural puncture headache pdph.

The original epidural catheter was removed and replaced with another, one interspace above. Postdural puncture headache and the development of the epidural blood. Inadvertent dural puncturewet tap and pdph management. Background meningeal postdural puncture headache mph is a familiar iatrogenic complication.

Practitioners of anesthesia are universally aware of postdural puncture headache pdph, yet our understanding of this serious complication remains surprisingly incomplete. Evaluation of incidence of postdural puncture headache. Epidural blood patch for postdural puncture headache due to. Postdural puncture headache and epidural blood patch use in elderly patients. Prophylactic epidural blood patch after unintentional dural puncture for the prevention of postdural puncture headache in parturients. In the remaining proportion of patients epidural blood patch is required, and it is effective and associated with low rate of complications. Epidural blood patch remains the treatment of choice. Epidural dextran 40 patch for postdural puncture headache.

Some have suggested that blood patch be performed as a prophylactic measure i. Postdural puncture headache and the development of the epidural. Risk of postdural puncture headache in adolescents and. Methergine methylergonovine maleate has been advocated for postdural puncture headache following spinal anesthesia. Prevention is key but an epidural blood patch is standard treatment in postdural puncture headache. Efficacy of a prophylactic epidural blood patch in preventing postdural puncture headache in parturients after inadvertent dural puncture. Reports that were supportive of this technique were based on nonrandomized observational studies. Mar 20, 2015 cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Blood patch is an effective treatment for post lp headache. Epidural blood patching for preventing and treating postdural puncture headache. Conservative treatment of pdph is effective in most patients. The optimum volume of blood has been shown to be 1220 ml for adult patients. After adjusting for covariates, the age group between 12 and 19 years was associated with an almost 3fold increase in the odds 2.

Pdf epidural blood patch for the treatment of post dural puncture. The vertebral space where the ebp was performed is depicted in figure 2. In 6070% people who have this kind of headache, the blood patch will cure the headache within 24 hours. Medline abstract for reference 100 of post dural puncture. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The investigators are curious regarding factors determining the incidence of postdural puncture headache in parturients undergoing cesarean section after epidural blood patch. We describe a novel use of an epidural blood patch ebp for treatment of persistent postdural puncture positional vertigo. Jun 04, 2018 postdural puncture headache pdph is a known consequence of lumbar puncture used for the diagnosis of neurological disorders, as well as during epidural anesthesia. Effectiveness of epidural blood patch in the management of. Epidural blood patch technique, recovery, and success rate. Oral paracetamol and caffeine combinations and intravenous hydration are also effective in symptomatic treatment. Headache and nuchal rigidity and photophobia after an. The incidence of accidental dural puncture adp during labor epidural insertion is approximately 1.

One such complication is postdural puncture headache pdph. The anaesthetist takes blood from your arm and injects it into your back, near to the hole in the dura. Although accidental dural puncture and postdural puncture headache pdph are on the radar of most anesthesiologists administering epidural analgesia, subsequent hearing loss is often overlooked. Theophylline for post dural puncture headache abstract. In highrisk patients, for example, age postpartum, largegauge needle puncture, epidural blood patch should be performed within 2448 h of dural puncture. Epidural blood patch for the management of postdural. Unintentional dural puncture followed by postdural puncture headache is a wellknown complication following neuraxial labor analgesia. This terminology has been officially adopted in the international classification of headache disorders and is used in this section.

The occurrence of post dural puncture headache after epidural blood patch time frame. The interlaminar approach is the most commonly used technique for an epidural blood patch. Postdural puncture headache pdph is a headache that may occur 24 to 48 hours after spinal anesthesia or inadvertent epidural subarachnoid puncture. In one study, the success rate of epb in a heterogeneous population that included parturients was 75%. Discomfort occurred in 391 cases 78% after administration of a blood volume of 19 5 ml. Postdural puncture headache and epidural blood patch in a large. Pdph is a complication of postdural puncture, where the sitting position cannot be adopted due to unbearable headache, forcing the patient to lie down.

Aug 11, 2010 some have suggested that blood patch be performed as a prophylactic measure i. Post dural puncture headache pdph is a complication of puncture of the dura mater one of the membranes around the brain and spinal cord. Post lumbar puncture lp headache is one of the most common complications from lps 6 36% incidence and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated. The literature assessing the use and safety of epidural blood patch in the elderly is sparse. A post dural puncture headache can be treated with an epidural blood patch. Oct 21, 2018 post dural puncture headache pdph was first described by august bier in 1898 and classically presents as a postural headache following therapeutic or diagnostic interventions of the epidural or spinal space.

Pdf epidural blood patch in post dural puncture headache. Curative treatment for the csf leak and postdural puncture headache frequently is accomplished with an epidural blood patch. Initial conservative therapy with analgesics, fluids and later two blood patches had no effect and the patients symptoms only resolved after an epidural dextran 40 patch performed 8 weeks. Hearing loss from dural puncture not uncommon, but is. Management of postdural puncture headache with epidural saline patch in a 10yearold child after inguinal hernia repair. Postdural puncture headache and epidural blood patch use. The headache is severe and described as searing and spreading like hot metal, involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness. August bier 1898 a personal experience of postdural puncture headache. An epidural blood patch should not be performed until 24 h after dural puncture to. It is postulated that blood injected in the epidural space increases the subarachnoid pressure by causing compression of the thecal sac and forces csf cephalad thereby immediately relieving the headache. It is thought to be due to a continuous leak of csf through the spinal puncture hole, decompressing the subarachnoid space with secondary stretching of the cranial nerves. Postduralpuncture headache an overview sciencedirect topics. Ebp provided complete relief from headache within 1530 minutes in 9 patients.

Confronting postdural puncture headache in clinical. Epidural blood patch for postdural puncture positional vertigo. His paper discussed the pathophysiology of lowpressure headache resulting from leakage of cerebrospinal fluid csf from the subarachnoid to the epidural space. Nonpharmacologic neuraxial interventions for prophylaxis of postdural puncture headache in the obstetric patient. Risk factors for the development of postdural puncture headache may be related to the patients history and characteristics, the neuraxial technique, and obstetrical events. Postdural puncture headache and epidural blood patch use in.

Postduralpuncture headache an overview sciencedirect. Toward the evening i was forced to take to bed and remained there for nine days, because all the manifestations recurred as soon as i got up. Epidural blood patch is an effective procedure in severe pdph. Postdural puncture bacterial meningitis anesthesiology.

We report a case where two consecutive blood patches failed to relieve postdural puncture headache and hearing loss following inadvertent dural puncture. Post dural punction headache pdph occurs in 10% to 40% of the patients who had a lumbar puncture. Postdural puncture headache advances in anesthesia. The influence of timing on the effectiveness of epidural blood patches in parturients. Postdural puncture headache is a leak of cerebrospinal fluid that lowers. Epidural blood patch epidural blood patch ebp in the first 24 hours after dural puncture has a lower success rate and a higher risk of bacteraemia. Various treatment modalities have been tried for postdural puncture headache pdph among which epidural blood patch ebp remains as the gold standard. Pathophysiology and management of postdural puncture headache.

Pdph is a relatively frequent complication of dural puncture with an estimated incidence of 2 3% after spinal anesthesia, but as high as 70% after inadvertent dural puncture during an epidural anesthetic. Exacerbation of postdural puncture headache after epidural. Postdural puncture headache remains a prominent clinical concern to the. The epidural blood patch is widely accepted as the treatment of choice for postdural puncture headache. Post dural puncture headache pdph, also known as post lumbar puncture lp headache, is a common complication of diagnostic lp. To determine the efficacy of epidural blood patch edbp for the treatment of post dural puncture headache pdph. However ebp has its own limitations and complicationsthe procedure is involved and requires collection of blood from the patient and injection of the blood into the epidural space. Cosyntropin versus epidural blood patch ebp for treatment. Postdural puncture headache pdph is a known consequence of lumbar puncture used for the diagnosis of neurological disorders, as well as during epidural anesthesia. Au harrington be, schmitt am so reg anesth pain med. Despite this, 48 hr later, she developed postdural puncture headache, neck, and shoulder pain, and was given a second epidural blood patch.

This case demonstrated that the epidural blood patch is one of the armaments at the. The overall incidence for the development of pdph in ambulatory patients epidural blood patch for treatment of postdural puncture headache in a patient with spinal fusion and recent implantation of intrathecal pain pump. Epidural blood patch for postdural puncture headache due. At midnight a violent headache set in that quickly became insupportable. Mar 31, 2014 the evidence is weak, but iv or oral caffeine does improve post lp headache, but with a high recurrence rate.

Meningeal postdural puncture headache, unintentional dural puncture, and the epidural blood patch. Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches pdphs. Uncontrolled studies report rapid recovery after patching in 90% to 100% of treated patients. Postdural puncture headache and the development of the epidural blood patch. Theophylline for postdural puncture headache abstract. It also can occur following spinal anesthesia or, more commonly, inadvertent dural puncture during attempted epidural catheter placement. Risk of postdural puncture headache in adolescents and adult. The technique of epidural blood patch has been described elsewhere. Epidural blood patch in post dural puncture headache. Efficacy of the epidural blood patch for the treatment of.

Management of postdural puncture headache in the obstetric patient. Headache is a common sequela of this procedure irrespective of the indication, although the frequency is less with spinal and epidural anaesthesia where fluid is. Not all patients have an epidural reinserted these days 2. Targeted transforaminal epidural blood patch for postdural.

Development of postdural puncture headache, headache severity, number of epidural blood patches, hospital length of stay. Postdural puncture headache and epidural blood patch the symptoms of a pdph sometimes are not a classic headache but are instead dizziness, auditory changes, visual disturbances, or neck pain that are positional in nature. The classic symptom of cerebrospinal fluid csf loss from disruption of spinal dura is headache associated with upright posture. However, despite earlier reports that this procedure was of value, subsequent studies have failed to show it has significant advantages over delayed blood patch. The differential diagnosis of headache after dural puncture is broad and includes pdph, nonspecific headache, migraine, caffeinewithdrawal headache, meningitis, sinus headache, pregnancyinduced hypertension preeclampsia, drugs cocaine, amphetamine, pneumocephalusrelated headache, cerebral venous thrombosis, subdural hematoma. Postdural puncture headache and epidural blood patch. Epidural blood patch in postdural puncture headache. Cosyntropin versus epidural blood patch ebp for treatment of treatment of post dural puncture headache pdph the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.

A postural component of headache is the sine qua non of pdph. T1 efficacy of a prophylactic epidural blood patch in preventing post dural puncture headache in parturients after inadvertent dural puncture. After this, if you still have a headache, you may be advised to have a second blood. Confronting postdural puncture headache in clinical practice. Mar 15, 2017 parturient after received spinal block for cesarean section who have post dural puncture headache and received epidural blood patch in siriraj hospital during 1 january 2006 to 30 december 2015 exclusion criteria. If conservative treatments are not successful, the. Effects of the serotonin receptor agonist sumatriptan on postdural puncture headache. Epidural anesthesia was attempted shortly after admission but was complicated by accidental dural puncture.

Jan 20, 2016 although accidental dural puncture and postdural puncture headache pdph are on the radar of most anesthesiologists administering epidural analgesia, subsequent hearing loss is often overlooked. Postdural puncture headache and the development of the epidural blood patch article in regional anesthesia and pain medicine 292. Epidural blood patch can cause acute neurologic deterioration. Postdural puncture headache and the development of the. This was followed by an immediate and severe exacerbation of her symptoms, which later resolved after the administration of diclofenac. Pdph is a relatively frequent complication of dural puncture with an estimated incidence of 2 3% after spinal anesthesia, but as high as 70% after inadvertent dural puncture during an. Yet, hearing impairment is a common occurrence following pdph, but one that can be improved by applying an epidural blood patch. Lumbar puncture is a procedure that is commonly performed in the emergency department ed for both diagnostic and therapeutic reasons. Although it is common practice to use epidural blood patch ebp to treat positional headache from postdural puncture pdp, the literature is limited to one letter to the editor describing pdp positional vertigo treated with ebp. In elderly patients, postdural puncture headache necessitating epidural blood patch is considered rare. The occurrence of post dural puncture headache after. Postdural puncture headache pdph was first described.

Clinical and laboratory research over the last 30 years has shown that use of smallgauge. Prophylactic epidural blood patch may prevent postdural puncture headache that develops after intentional or inadvertent dural puncture. Postdural puncture headache pdph has been a problem for patients, following dural puncture, since august bier reported the first case in 1898. This feels similar to having the original epidural or spinal injection. Editorepidural blood patch ebp has been shown to be effective in either complete resolution of symptoms or in marked reduction in the severity of postdural puncture headache pdph.

It should be considered only in moderate to severe headache not responsive to conservative management and. In these cases, symptomatic therapies such as hydration, abdominal binders, and caffeine administration can be performed, while an epidural blood. Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. Efficacy of a prophylactic epidural blood patch in.