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Uyar Türkyilmaz E, Eryilmaz NC, Güzey NA, Moraloğlu Ö. Bloqueio bilateral do nervo occipital maior para tratamento de cefaleia pós‐punção dural após cesarianas. Braz J Anesthesiol 2016; 66:445-50. [DOI: 10.1016/j.bjan.2015.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/23/2015] [Indexed: 10/21/2022] Open
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Uyar Türkyilmaz E, Camgöz Eryilmaz N, Aydin Güzey N, Moraloğlu Ö. Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations. Braz J Anesthesiol 2016; 66:445-50. [PMID: 27591456 DOI: 10.1016/j.bjane.2015.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. METHODS 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. RESULTS The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. CONCLUSIONS Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch.
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Affiliation(s)
- Esra Uyar Türkyilmaz
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey.
| | - Nuray Camgöz Eryilmaz
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Nihan Aydin Güzey
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Anesthesiology and Reanimation, Ankara, Turkey
| | - Özlem Moraloğlu
- Zekai Tahir Burak Womens' Health Training and Research Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey
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Abdulla S, Vielhaber S, Heinze HJ, Abdulla W. A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange. Int J Crit Illn Inj Sci 2015; 5:93-8. [PMID: 26157652 PMCID: PMC4477403 DOI: 10.4103/2229-5151.158395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described. Materials and Methods: In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability. Results: From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease. Conclusions: A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.
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Affiliation(s)
- Susanne Abdulla
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany
| | - Hans-Jochen Heinze
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany ; German Center for Neurodegenerative Diseases, Magdeburg, Germany ; Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Walied Abdulla
- Department of Anesthesiology and Intensive Care Medicine, Klinikum Bernburg, Martin Luther-University Halle-Wittenberg, Bernburg, Germany ; Johannes Gutenberg University Mainz, Mainz, Germany
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Baysinger CL, Pope JE, Lockhart EM, Mercaldo ND. The management of accidental dural puncture and postdural puncture headache: a North American survey. J Clin Anesth 2011; 23:349-60. [PMID: 21696932 DOI: 10.1016/j.jclinane.2011.04.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 03/21/2011] [Accepted: 04/20/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Curtis L Baysinger
- Division of Obstetric Anesthesia, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Klein A, Loder E. Postpartum headache. Int J Obstet Anesth 2010; 19:422-30. [DOI: 10.1016/j.ijoa.2010.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Revised: 01/27/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
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Meningeal (postdural) puncture headache, unintentional dural puncture, and the epidural blood patch: a national survey of United States practice. Reg Anesth Pain Med 2009; 34:430-7. [PMID: 19749586 DOI: 10.1097/aap.0b013e3181b493e9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Meningeal (postdural) puncture headache (MPH) is a familiar iatrogenic complication. The optimal means of prevention, management, and treatment of this disorder are uncertain. The purpose of this study was to determine current practice among United States (USA) anesthesiologists regarding MPH as well as the related issues of unintentional dural puncture (UDP), the epidural blood patch (EBP), and proposed alternatives to the EBP. METHODS A survey form was sent as a single mailing to each practicing USA member of the American Society of Regional Anesthesia and Pain Medicine in June 2006. RESULTS Data were analyzed from 1024 returned survey forms (29.4% response rate). Major findings were as follows: Written institutional protocols for managing UDP and MPH are uncommon. The preferred method of immediately dealing with an UDP when providing analgesia for labor is to reattempt the epidural at another level (73.4%). When intrathecal catheters are used for labor analgesia, they are most often removed immediately after delivery (56.5%). After UDP in the obstetric setting, aggressive hydration and encouraging bed rest are the most frequently used prophylactic measures against the development of MPH. Frequently used treatment options for MPH include aggressive hydration, the EBP, oral caffeine, oral nonopioid analgesics, and bed rest. With the exception of a uniform blood volume (16-20 mL), procedural details of the EBP vary considerably among practitioners. The use of materials other than blood for epidural patch is uncommon. CONCLUSIONS Various measures, many poorly supported by the literature, are used prophylactically after UDP and in the treatment of MPH. Despite being nearly universally used as treatment of MPH, the EBP procedure itself remains largely nonstandardized.
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Kuczkowski KM. The management of accidental dural puncture in pregnant women: what does an obstetrician need to know? Arch Gynecol Obstet 2006; 275:125-31. [PMID: 16532322 DOI: 10.1007/s00404-006-0146-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 02/10/2006] [Indexed: 11/28/2022]
Abstract
Post-dural puncture headache (PDPH) also known as spinal (or post-spinal) headache still remains a disabling complication of needle insertion into the subarachnoid space. Pregnant women are at particular risk of dural puncture, and the subsequent headache, because of sex, young age, and the widespread application of regional anesthesia. Accidental dural puncture complicating epidural anesthesia varies in incidence from 0.19 to 4.4%. The incidence of epidural needle-induced PDPH headache in pregnant women has been reported to range 76-85%. The classic symptoms of PDPH consist of photophobia, nausea, vomiting, neck stiffness, tinnitus, diplopia, and dizziness in addition to the often, severe cephalgia. This article reviews the current literature on the pathophysiology, incidence, prevention, and treatment of PDPH in pregnant women.
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Affiliation(s)
- Krzysztof M Kuczkowski
- Department of Anesthesiology, UCSD Medical Center, University of California, 200 West Arbor Drive, San Diego, CA 92103-8770, USA.
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Dyson DH, Sparling SC. Delay in final publication following abstract presentation: American College of Veterinary Anesthesiologists annual meeting. JOURNAL OF VETERINARY MEDICAL EDUCATION 2006; 33:145-8. [PMID: 16767655 DOI: 10.3138/jvme.33.1.145] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
RATIONALE FOR THE STUDY A review of abstracts presented at nine annual meetings of the American College of Veterinary Anesthesiologists was undertaken to determine the average time to publication and the differences found between conference abstracts and final publications. Concerns about and advantages of using such abstracts in our teaching are considered. METHODOLOGY Conference proceedings during the years 1990 through 1999 were considered. Key word and author searches using two common search engines were carried out to find whether abstracts presented had been published. The original article or its abstract was reviewed for consistency with the conference abstract. RESULTS Of 283 abstracts examined, 73.5% were published in journals as full articles. The overall delay (+/-SD) in publication was 24.3 +/- 21.0 months. Common reasons for not publishing included too little time, more interest in carrying out the work than in writing it up, and other more demanding tasks. Authors indicated the intention of completing a submission on approximately 10% of the unpublished abstracts. The final articles reviewed showed major differences in key aspects from the abstract presented in 7% of the cases. In half of these cases, clinical action could have been affected by a change in emphasis of the conclusions. CONCLUSIONS Because of the delay in publication of research, peer review of standardized abstracts should be encouraged. This material can be used to introduce students to new drugs, techniques, and results that may not otherwise become available until after their graduation. However, caution must be exercised in using this information, both because significant differences were noted in final publications and because unpublished research may be poorly interpreted at the time of presentation. This study emphasizes the value of critical review and lifelong learning in our careers.
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Affiliation(s)
- Doris H Dyson
- Ontario Veterinary College, University of Guelph, Canada.
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Angle P, Tang SLT, Thompson D, Szalai JP. Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits. Can J Anaesth 2005; 52:397-402. [PMID: 15814755 DOI: 10.1007/bf03016283] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION PDPH leads to a significant increase in hospital LOS and ER visits. Studies of preventive therapy are warranted.
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Affiliation(s)
- Pamela Angle
- Department of Anesthesiology, Women's College Hospital Campus, Sunnybrook and Women's College Health Sciences Center, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
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Wong AYC. Is PDPH from a 25-gauge Whitacre needle always short-lasting and self-resolving? Can J Anaesth 2004; 51:637; author reply 637-8. [PMID: 15197130 DOI: 10.1007/bf03018409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
We conducted a prospective, randomised, double-blind trial to study the effect of Synacthen Depot in 18 parturients with postdural puncture headache following deliberate or accidental dural puncture. Women were randomly allocated to receive either Synacthen Depot 1 mg (1 ml) or 0.9% saline 1 ml intramuscularly. Using a 10-cm visual analogue scale, severity of headache was measured before and at intervals until 48 h after injection. There was no difference in the severity of headache or requirement for epidural blood patch. We conclude that there is no advantage to the use of Synacthen Depot 1 mg for the treatment of postdural puncture headache.
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Affiliation(s)
- M W M Rucklidge
- Magill Department of Anaesthesia, Intensive Care & Pain Management, Chelsea and Westminster Hospital, London SW10 9NH, UK
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Choi PT, Galinski SE, Takeuchi L, Lucas S, Tamayo C, Jadad AR. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth 2003; 50:460-9. [PMID: 12734154 DOI: 10.1007/bf03021057] [Citation(s) in RCA: 211] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency, onset, and duration of PDPH. METHODS Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental dural puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles. RESULTS Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental dural puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after dural puncture and lasts 12 hr to seven days. CONCLUSION PDPH is a common complication for parturients undergoing neuraxial blockade.
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Affiliation(s)
- Peter T Choi
- Department of Anesthesia, St. Joseph's Healthcare and McMaster University, 1200 Main Street West, Room HSC-2U5, Hamilton, Ontario L8N 3Z5, Canada.
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