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Greige T, Edlow JA. Managing Acute Headache in Pregnant and Postpartum Women. Ann Emerg Med 2024; 84:51-59. [PMID: 38597849 DOI: 10.1016/j.annemergmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Tatiana Greige
- Department of Neurology, Boston Medical Center, Boston, MA.
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Lim RS, Chan EK, Das PP, Ibrahim T. Post-caesarean Section Headache: A Case Report of Post-dural Puncture Headache and Cerebral Venous Thrombosis Following Epidural Anaesthesia. Cureus 2024; 16:e60183. [PMID: 38868268 PMCID: PMC11167682 DOI: 10.7759/cureus.60183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/14/2024] Open
Abstract
Post-dural puncture headache (PDPH) is a common complication of epidural and spinal anaesthesia in obstetric medicine. In rare cases, PDPH can be associated with complications such as cerebral venous thrombosis (CVT) as well. We discuss a recent case of a young female who developed PDPH and CVT concurrently after undergoing epidural anaesthesia for initially uncomplicated labour and delivered via an emergency caesarean section. She developed an orthostatic headache a few hours post administration of the epidural anaesthetic, which was initially treated as a suspected PDPH by giving simple analgesia and caffeine. Her symptoms did not improve and she underwent further neuroimaging, which revealed the development of a CVT. Despite the prompt administration of enoxaparin, the headache persisted and did not respond to increased doses of analgesia. After deliberation and inter-departmental discussion, an epidural blood patch was performed, leading to the prompt resolution of the headache. This report highlights a rare concurrence of PDPH and CVT, causing a diagnostic dilemma that resulted in treatment delays for the patient. Treating both conditions raises difficult practical questions, especially regarding the use of an epidural blood patch as opposed to anticoagulation. Given the risk of fatal complications such as venous cerebral infarction, seizures, and subdural hematoma, prompt treatment of both PDPH and CVT is strongly recommended. The multifactorial mechanism by which CVT develops with intracranial hypotension and PDPH also makes it essential for clinicians to keep an open mind when managing post-caesarean headaches, requiring inter-departmental cooperation to ensure optimal patient outcomes.
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Affiliation(s)
- Rachael S Lim
- Critical Care, Goulburn Valley Health, Shepparton, AUS
| | - Ethan K Chan
- General Medicine, Goulburn Valley Health, Shepparton, AUS
| | - Partha P Das
- General Medicine, Goulburn Valley Health, Shepparton, AUS
| | - Tunde Ibrahim
- General Medicine, Goulburn Valley Health, Shepparton, AUS
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Kim JK, Lee HY, Kim HY, Kwak MY. A hidden pathophysiology of endolymphatic hydrops: case report of a patient with spontaneous intracranial hypotension presenting with sudden sensorineural hearing loss with vertigo. Front Neurol 2024; 15:1394534. [PMID: 38645745 PMCID: PMC11026624 DOI: 10.3389/fneur.2024.1394534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Spontaneous intracranial hypotension (SIH) is characterized by decreased cerebrospinal fluid (CSF) volume due to leakage through the dural membrane. We present the case of a patient with SIH manifested by fluctuating low-frequency hearing loss, tinnitus, and vertigo. In this patient, endolymphatic hydrops in the cochlea and saccule were visualized by means of a special sequence of inner ear magnetic resonance imaging scans, with a gadolinium-based contrast agent administered intravenously. Endolymphatic hydrops is a potential underlying pathophysiology of SIH-associated hearing impairment. We hypothesize that SIH may be a rare cause of endolymphatic hydrops.
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Affiliation(s)
- Jong Kwan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Ho Yun Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ha Youn Kim
- Department of Radiology, Daejeon Eulji Medical Center, Eulji University, Daejeon, Republic of Korea
| | - Min Young Kwak
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
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Zduńska A, Cegielska J, Zduński S, Domitrz I. Caffeine for Headaches: Helpful or Harmful? A Brief Review of the Literature. Nutrients 2023; 15:3170. [PMID: 37513588 PMCID: PMC10385675 DOI: 10.3390/nu15143170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Consumption of caffeine in the diet, both daily and occasional, has a significant biological effect on the nervous system. Caffeine, through various and not yet fully investigated mechanisms, affects headaches. This is especially noticeable in migraine. In other headaches such as hypnic headache, post-dural puncture headache and spontaneous intracranial hypotension, caffeine is an important therapeutic agent. In turn, abrupt discontinuation of chronically used caffeine can cause caffeine-withdrawal headache. Caffeine can both relieve and trigger headaches.
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Affiliation(s)
- Anna Zduńska
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, 01-809 Warsaw, Poland
| | - Joanna Cegielska
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, 01-809 Warsaw, Poland
| | - Sebastian Zduński
- Medical Rehabilitation Facility, The National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland
| | - Izabela Domitrz
- Department of Neurology, Faculty of Medicine and Dentistry, Medical University of Warsaw, 01-809 Warsaw, Poland
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Schyns-van den Berg AM, Gupta A. Postdural puncture headache - revisited. Best Pract Res Clin Anaesthesiol 2023. [DOI: 10.1016/j.bpa.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Boppana SH, Peterson M, Du A, Gabriel RA, Kutikuppala LVS. Caffeine: What Is Its Role in Pain Medicine? Cureus 2022; 14:e25603. [PMID: 35795518 PMCID: PMC9250334 DOI: 10.7759/cureus.25603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Caffeine is the world's most widely used psychoactive legal substance. The involvement of caffeine in pain management has gotten minimal attention in the past, but it is getting more attention now. This article provides a brief assessment of the literature to clarify the role of caffeine as a pain reliever and stimulate the interest of researchers. Caffeine affects adenosine receptors, which are involved in nociception, and plays a significant role in pain regulation. Caffeine's usage as an adjuvant therapy has been extensively documented in the literature, and it is now accessible in certain over-the-counter drugs. The mixture of coffee and morphine for pain reduction in individuals with terminal cancer has shown mixed outcomes in studies. Caffeine can be utilized for hypnic headaches and post-dural puncture headaches since it is crucial in pain regulation. Caffeine has the potential to help in pain management. Caffeine's usage for migraines and end-stage cancer disease is not well acknowledged. Further research is essential to focus on caffeine's potential role in various forms of pain, including dosage escalation and outcome assessment standardization.
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Valença MM, e Sousa MSSM, Valença MA, Carvalho DED, Silva AHTTD, Andrade JRD. It is wrong to treat pain in CSF hypotension headache to allow the patient to walk! HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
It is wrong to treat pain in CSF hypotension headache to allow the patient to walk!
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Waters JFR. Neurologic Complications of Obstetric Anesthesia. Continuum (Minneap Minn) 2022; 28:162-179. [DOI: 10.1212/con.0000000000001073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Schorling DC, Pechmann A, Eckenweiler M, Müller CK, Langer T, Kirschner J. Post-dural puncture headache-a single-centre analysis in paediatric patients with and without SMA. Acta Paediatr 2021; 110:1895-1901. [PMID: 33548068 DOI: 10.1111/apa.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
AIM To gather epidemiologic data on post-dural puncture headache (PDPH) after diagnostic or therapeutic lumbar puncture (LP) in children and adolescents with SMA as well as in a cohort of paediatric patients without SMA. METHODS We performed a retrospective, single-centre analysis via chart review and questionnaire. Patients were identified using the German procedure classification. Respective charts and SMArtCARE documentation forms (SMA patients) were reviewed concerning documentation of headaches fulfilling criteria of the IHS-classification for PDPH of 2004. Non-SMA patients received additional questionnaires. RESULTS We identified a total of 218 LPs in 95 patients. Of those 141 were performed in 22 patients with known SMA (mean age SMA patients 9.2 years; non-SMA patients 11.4 years). Following chart review, IHS criteria for PDPH were fulfilled in 6.9% of all procedures (3.5% in SMA patients; 13.0% in non-SMA patients; p = 0.008). Data from questionnaires of non-SMA patients confirmed this result (position dependent headache within 72 h after intervention in 13.0% of procedures). CONCLUSION The prevalence of PDPH after therapeutic LPs in our cohort of SMA patients was significantly lower than after LPs in the general paediatric cohort. Data of this retrospective analysis show a similar overall prevalence of PDPH in paediatric patients as reported in bigger adult cohorts.
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Affiliation(s)
- David C. Schorling
- Department of Neuropediatrics and Muscle Disorders Medical Center University of Freiburg Faculty of Medicine University of Freiburg Germany
| | - Astrid Pechmann
- Department of Neuropediatrics and Muscle Disorders Medical Center University of Freiburg Faculty of Medicine University of Freiburg Germany
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders Medical Center University of Freiburg Faculty of Medicine University of Freiburg Germany
| | - Cornelia K. Müller
- Department of Neuropediatrics and Muscle Disorders Medical Center University of Freiburg Faculty of Medicine University of Freiburg Germany
| | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disorders Medical Center University of Freiburg Faculty of Medicine University of Freiburg Germany
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle Disorders Medical Center University of Freiburg Faculty of Medicine University of Freiburg Germany
- Department of Neuropediatrics University Hospital Bonn Germany
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Cognat E, Koehl B, Lilamand M, Goutagny S, Belbachir A, de Charentenay L, Guiddir T, Zetlaoui P, Roos C, Paquet C. Preventing Post-Lumbar Puncture Headache. Ann Emerg Med 2021; 78:443-450. [PMID: 33966935 DOI: 10.1016/j.annemergmed.2021.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
Post-lumbar puncture headache is the main adverse event from lumbar puncture and occurs in 3.5% to 33% of patients, causing functional and socio-professional disability. We searched the post-lumbar puncture headache literature and, based on this review and personal expertise, identified and addressed 19 frequently asked questions regarding post-lumbar puncture headache risk factors and prevention. Among the nonmodifiable factors, older age is associated with a lower incidence of post-lumbar puncture headache, while female sex, lower body mass index, and history of headache might be associated with increased risk. The use of atraumatic, noncutting needles is the most effective intervention for post-lumbar puncture headache prevention. These needles are not more difficult to use than cutting needles. Other commonly recommended measures (eg, fluid supplementation, caffeine) appear unhelpful, and some (eg, bed rest) may worsen post-lumbar puncture headache.
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Affiliation(s)
- Emmanuel Cognat
- Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France.
| | - Berengère Koehl
- Sickle Cell Disease Center, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Robert Debré, Paris, France
| | - Matthieu Lilamand
- Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France; Sickle Cell Disease Center, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Robert Debré, Paris, France; Département de Gériatrie, Assistance Publique Hôpitaux de Paris, APHP.Nord, Sites Bichat et Bretonneau, Paris, France
| | - Stéphane Goutagny
- Service de Neurochirurgie, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Beaujon, Clichy, France
| | - Anissa Belbachir
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Louise de Charentenay
- Service d'Anesthésie Réanimation, UF Douleur, Assistance Publique Hôpitaux de Paris, APHP.Centre, Site Cochin, Paris, France
| | - Tamazoust Guiddir
- Service de Pédiatrie, Assistance Publique Hôpitaux de Paris, APHP.Sud, Site Bicêtre, Le Kremlin-Bicêtre, France
| | - Paul Zetlaoui
- Service d'Anesthésie-Réanimation, Assistance Publique Hôpitaux de Paris, APHP.Sud, Site Bicêtre, Le Kremlin-Bicêtre, France
| | - Caroline Roos
- Centre d'Urgence des Céphalées, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris, France
| | - Claire Paquet
- Université de Paris, UMRS 1144, INSERM, Paris, France; Centre de Neurologie Cognitive, Assistance Publique Hôpitaux de Paris, APHP.Nord, Site Lariboisière Fernand-Widal, Paris France
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11
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Rodríguez R, López Gómez A, Zebdi N, Ríos Barrera R, Forteza A, Legarra Calderón JJ, Garrido Martín P, Hernando B, Sanjuan A, González Bardanca S, Varela Martínez MÁ, Fernández FE, Llorens R, Valera Martínez FJ, Gómez Felices A, Aranda Granados PJ, Sádaba Sagredo R, Echevarría JR, Guillén RV, Silva Guisasola J. RETRACTED: Anesthesic and surgical guideline for the treatment of the thoraco-abdominal aorta. Consensus Document of the Spanish Societies of Anesthesia and Cardiovascular Surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:258-279. [PMID: 33775419 DOI: 10.1016/j.redar.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022]
Abstract
Este artículo ha sido retirado por indicación del Editor Jefe de la revista, después de constatar que parte de su contenido había sido plagiado, sin mencionar la fuente original: European Heart Journal (2014) 35, 2873 926.: https://academic.oup.com/eurheartj/article/35/41/2873/407693#89325738 El autor de correspondencia ha sido informado de la decisión y está de acuerdo con la retirada del artículo. El Comité Editorial lamenta las molestias que esta decisión pueda ocasionar. Puede consultar la política de Elsevier sobre la retirada de artículos en https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- R Rodríguez
- Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - A López Gómez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - N Zebdi
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - R Ríos Barrera
- Servicio de Cirugía Cardiaca, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - A Forteza
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - P Garrido Martín
- Servicio de Cirugía Cardiaca, Hospital Universitario de Canarias, España
| | - B Hernando
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Sanjuan
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Miguel Servet, Zaragoza, España
| | - S González Bardanca
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Complejo Hospitalario Universitario de A Coruña, España
| | - M Á Varela Martínez
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Álvaro Cunqueiro de Vigo, España
| | - F E Fernández
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Central de Asturias, España
| | - R Llorens
- Servicio de Cirugía Cardiaca, Hospital Hospiten Rambla, Tenerife, España
| | - F J Valera Martínez
- Servicio de Cirugía Cardiaca, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Gómez Felices
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario Vall d'Hebron, Barcelona, España
| | | | - R Sádaba Sagredo
- Servicio de Cirugía Cardiaca. Complejo Hospitalario de Navarra, España
| | - J R Echevarría
- Servicio de Cirugía Cardíaca. Hospital Universitario de Valladolid, España
| | - R V Guillén
- Servicio de Anestesiología, Reanimación y Terapéutica del dolor, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - J Silva Guisasola
- Servicio de Cirugía Cardíaca. Hospital Universitario Central de Asturias, España
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RETRACTED: Guía anestésico-quirúrgica en el tratamiento de la patología de aorta toracoabdominal. Documento de Consenso de la Sociedad Española de Cirugía Cardiovascular Endovascular y la Sociedad Española de Anestesiología, Reanimación y Terapeútica del Dolor. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Gandhi J, DiMatteo A, Joshi G, Smith NL, Khan SA. Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management. Int J Neurosci 2020; 131:689-695. [PMID: 32242448 DOI: 10.1080/00207454.2020.1751625] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Damage to the dura mater often occurs in trauma cases of the head and spine, surgical procedures, lumbar punctures, and meningeal diseases. The resulting damage from dural tears, or durotomy, causes cerebrospinal fluid (CSF) to leak out into the surrounding space. The CSF leak induces intracranial hypotension, which can clinically present with a range of symptoms not limited to positional headaches which can confound accurate diagnosis. Current methods of evaluation and management of dural tears are discussed herewith, as well as the present understanding of its etiology, which may be classified as related to surgery, procedure, trauma, or connective tissue disorder. METHODS We piloted a MEDLINE® database search of literature, with emphasis on the previous five years, combining keywords such as "cerebrospinal fluid leak," "surgery," "procedure," and "trauma" to yield original research articles and case reports for building a clinical profile. RESULTS Patients with suspected dural tears should be evaluated based on criteria set by the International Headache Society, radiological findings, and a differential diagnosis to accurately identify the tear and its potential secondary complications. Afflicted patients may be treated promptly with epidural blood patches, epidural infusions, epidural fibrin glue, or surgical repair. At this time, epidural blood patches are the first line of treatment. Dural tears can be prevented to an extent by utilizing minimally invasive techniques and certain positions for lumbar puncture. Surgical, trauma, lumbar puncture, and epidural injection patients should be observed very carefully for dural tears and CSF leaks as the presenting clinical manifestations can be highly individualized and misguiding. CONCLUSION Because studies have demonstrated a high frequency of dural tears, particularly in spinal surgery patients, there is a need for prospective studies so that clinicians can develop an elaborate prevention strategy and response to avoid serious, unseen complications.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Medical Student Research Institute, St. George's University School of Medicine, Grenada, West Indies
| | - Andrew DiMatteo
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Gunjan Joshi
- Department of Internal Medicine, Stony Brook Southampton Hospital, Southampton, NY, USA
| | | | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.,Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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14
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Bitargil M, El Kılıç H. Our experience regarding patients with headache, vomiting, and urinary retention following endothermal ablation of the greater saphenous vein under spinal anesthesia: Gender type, age interval, and procedural risk factors are important. Vascular 2020; 28:591-596. [PMID: 32216537 DOI: 10.1177/1708538120911302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The endovenous thermal ablation of the greater saphenous vein under spinal anesthesia is still a popular technique. Although this procedure is considered to be fast and simple, side effects such as headaches, vomiting, and urinary retention could occur. These side effects make the recovery period difficult for the patient. The patient's age, gender, and procedural risk factors such as needle sizes and types are important parameters that affect the occurrence and rate of undesirable outcomes. This retrospective study aims to evaluate the endovenous thermal ablation method for the management of incompetent great saphenous veins under spinal anesthesia. METHODS A total of 128 patients with incompetent varicose veins who were treated with an endovenous thermal ablation method under spinal anesthesia were retrospectively investigated between January 2016 and January 2019. The pre-, intra-, post-procedural, and follow-up data of the patients were collected and retrospectively compared. RESULTS A total of 128 patients (69 males, 59 females; mean age 45.8 ± 11.8 years; range 21-71 years) were included in the study. The average preprocedural great saphenous vein diameters were 7.41 ± 18.8 mm (range: 5.5-13.0). The average ablated vein length was 25.3 ± 3.4 (range: 15-35) cm. The average tumescent anesthesia use was 300.9 ± 52.6 (range: 150-500) mL. The average procedure time was 18.2 ± 1.8 (range: 11-25) min. The venous clinical severity scores and the chronic venous insufficiency quality of life questionnaire scores declined significantly (p for venous clinical severity scores: 0.001, p for chronic venous insufficiency quality of life questionnaire scores: 0.001). There was no postoperative paresis or paresthesia. There was one case of deep venous thrombosis and three cases of bruising. The total of three months' occlusion rates was 96.9% (124/128).The overall post-dural puncture headache ratio was 18%. Women significantly suffered from more headaches than men (27% vs. 10%, p = 0.013). The extreme age intervals (pertaining to ages between 18 and 30 or 50+) were almost significantly less affected by headaches in comparison to the group with the age interval between 31 and 50 (11.3%, 24.2%, p: 0.056). A percentage of 12.5 patients suffered from vomiting. It was recorded that female patients suffered from vomiting more so than the males (20.3%, 5.8%, p: 0.013). Pertaining to vomiting, there was no significant difference between the two age interval groups (p: 0.14). Urinary retention was observed in 6.3% of the patients. The female gender had a higher ratio of urinary retention, but the difference was insignificant. (8.5%, 4.3%, p: 0.46). There was no significant difference between the age interval groups in terms of urinary retention. CONCLUSIONS The endovenous thermal ablation of the greater saphenous vein under spinal anesthesia is a fast and effective treatment option for the management of incompetent saphenous veins. However, side effects such as headaches, vomiting, and urinary retention that are affected by gender types, age-intervals, and procedural characteristics should be kept in mind.
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Affiliation(s)
- Macit Bitargil
- Department of Cardiovascular Surgery, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
| | - Helin El Kılıç
- Department of Cardiovascular Surgery, Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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Riveros Perez E, Sanchez MG, Rocuts A, Jimenez E. Use of a Triple Prophylactic Strategy to Prevent Post-dural Puncture Headache: An Observational Study. Cureus 2020; 12:e7052. [PMID: 32219046 PMCID: PMC7086110 DOI: 10.7759/cureus.7052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective Post-dural puncture headache (PDPH) after an accidental dural puncture is a very common complication of epidural analgesia/anesthesia. We observed the ability of a triple prophylactic method (epidural saline, morphine, and intravenous (IV) cosyntropin) to prevent PDPH and the need for a blood patch. Methods We retrospectively evaluated the effect of the combination of epidural saline, IV cosyntropin, and epidural morphine in parturients who had an accidental dural puncture with regard to the PDPH rate and the need for an epidural blood patch. We report a case series of patients with accidental dural puncture who underwent triple prophylaxis and other methods. Results Thirty-one patients were included in the study. Fourteen cases received triple prophylaxis (45%). Three patients in this group developed PDPH (21%), with two of them requiring a blood patch (14%). Nine patients underwent preventive measures other than triple prophylaxis with a PDPH rate of 55% and one needing a blood patch (11%). Conservative management was used in eight patients with PDPH and blood patch rates of 100% and 62%, respectively. Conclusion The triple prophylactic regimen of epidural saline, IV cosyntropin, and epidural morphine used after accidental dural puncture exhibits great potential to reduce the incidence of PDPH and the need for blood patch in obstetric patients.
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Affiliation(s)
- Efrain Riveros Perez
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Maria G Sanchez
- Anesthesiology and Perioperative Medicine, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Alexander Rocuts
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Enoe Jimenez
- Anesthesiology, The Medical College of Georgia, Augusta University, Augusta, USA
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Ragab A, Facharzt KN. Caffeine, Is it effective for prevention of postdural puncture headache in young adult patients? EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2013.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ashraf Ragab
- Assistant Professor of Anesthesia, Faculty of Medicine , Cairo University , Egypt
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Treatment of obstetric post-dural puncture headache. Part 1: conservative and pharmacological management. Int J Obstet Anesth 2019; 38:93-103. [DOI: 10.1016/j.ijoa.2018.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/12/2018] [Accepted: 12/16/2018] [Indexed: 12/18/2022]
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Dabas R, Lim MJ, Sng BL. Postdural puncture headache in obstetric neuraxial anaesthesia: Current evidence and therapy. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.1016/j.tacc.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Simard T, Jung R, Labinaz A, Faraz MA, Ramirez FD, Di Santo P, Pitcher I, Motazedian P, Gaudet C, Rochman R, Marbach J, Boland P, Sarathy K, Alghofaili S, Russo JJ, Couture E, Beanlands RS, Hibbert B. Adenosine as a Marker and Mediator of Cardiovascular Homeostasis: A Translational Perspective. Cardiovasc Hematol Disord Drug Targets 2019; 19:109-131. [PMID: 30318008 DOI: 10.2174/1871529x18666181011103719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/08/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
Adenosine, a purine nucleoside, is produced broadly and implicated in the homeostasis of many cells and tissues. It signals predominantly via 4 purinergic adenosine receptors (ADORs) - ADORA1, ADORA2A, ADORA2B and ADOosine signaling, both through design as specific ADOR agonists and antagonists and as offtarget effects of existing anti-platelet medications. Despite this, adenosine has yet to be firmly established as either a therapeutic or a prognostic tool in clinical medicine to date. Herein, we provide a bench-to-bedside review of adenosine biology, highlighting the key considerations for further translational development of this proRA3 in addition to non-ADOR mediated effects. Through these signaling mechanisms, adenosine exerts effects on numerous cell types crucial to maintaining vascular homeostasis, especially following vascular injury. Both in vitro and in vivo models have provided considerable insights into adenosine signaling and identified targets for therapeutic intervention. Numerous pharmacologic agents have been developed that modulate adenmising molecule.
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Affiliation(s)
- Trevor Simard
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Canada
| | - Richard Jung
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Canada
| | - Alisha Labinaz
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | | | - F Daniel Ramirez
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Pietro Di Santo
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Ian Pitcher
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Pouya Motazedian
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, ON, Canada
| | - Chantal Gaudet
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Rebecca Rochman
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Jeffrey Marbach
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Paul Boland
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Kiran Sarathy
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Saleh Alghofaili
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Juan J Russo
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Etienne Couture
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
| | - Rob S Beanlands
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Canada
| | - Benjamin Hibbert
- CAPITAL research group, Division of Cardiology, University of Ottawa Heart Institute, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Canada
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Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K. Caffeine in the management of patients with headache. J Headache Pain 2017; 18:107. [PMID: 29067618 PMCID: PMC5655397 DOI: 10.1186/s10194-017-0806-2] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 09/08/2017] [Indexed: 01/03/2023] Open
Abstract
Caffeinated headache medications, either alone or in combination with other treatments, are widely used by patients with headache. Clinicians should be familiar with their use as well as the chemistry, pharmacology, dietary and medical sources, clinical benefits, and potential safety issues of caffeine. In this review, we consider the role of caffeine in the over-the-counter treatment of headache. The MEDLINE and Cochrane databases were searched by combining “caffeine” with the terms “headache,” “migraine,” and “tension-type.” Studies that were not placebo-controlled or that involved medications available only with a prescription, as well as those not assessing patients with migraine and/or tension-type headache (TTH), were excluded. Compared with analgesic medication alone, combinations of caffeine with analgesic medications, including acetaminophen, acetylsalicylic acid, and ibuprofen, showed significantly improved efficacy in the treatment of patients with TTH or migraine, with favorable tolerability in the vast majority of patients. The most common adverse events were nervousness (6.5%), nausea (4.3%), abdominal pain/discomfort (4.1%), and dizziness (3.2%). This review provides evidence for the role of caffeine as an analgesic adjuvant in the acute treatment of primary headache with over-the-counter drugs, caffeine doses of 130 mg enhance the efficacy of analgesics in TTH and doses of ≥100 mg enhance benefits in migraine. Additional studies are needed to assess the relationship between caffeine dosing and clinical benefits in patients with TTH and migraine.
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Affiliation(s)
- Richard B Lipton
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Louis and Dora Rousso Building, 1165 Morris Park Avenue, Room 332, Bronx, NY, 10461, USA.
| | | | - Matthew S Robbins
- Montefiore Headache Center, Department of Neurology, Albert Einstein College of Medicine, Louis and Dora Rousso Building, 1165 Morris Park Avenue, Room 332, Bronx, NY, 10461, USA
| | | | - Ketu Patel
- GlaxoSmithKline Consumer Healthcare, Parsippany, NJ, USA
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Veličković I, Pujic B, Baysinger CW, Baysinger CL. Continuous Spinal Anesthesia for Obstetric Anesthesia and Analgesia. Front Med (Lausanne) 2017; 4:133. [PMID: 28861414 PMCID: PMC5559441 DOI: 10.3389/fmed.2017.00133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 07/25/2017] [Indexed: 01/24/2023] Open
Abstract
The widespread use of continuous spinal anesthesia (CSA) in obstetrics has been slow because of the high risk for post-dural puncture headache (PDPH) associated with epidural needles and catheters. New advances in equipment and technique have not significantly overcome this disadvantage. However, CSA offers an alternative to epidural anesthesia in morbidly obese women, women with severe cardiac disease, and patients with prior spinal surgery. It should be strongly considered in parturients who receive an accidental dural puncture with a large bore needle, on the basis of recent work suggesting significant reduction in PDPH when intrathecal catheters are used. Small doses of drug can be administered and extension of labor analgesia for emergency cesarean delivery may occur more rapidly compared to continuous epidural techniques.
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Affiliation(s)
- Ivan Veličković
- Department of Anesthesiology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Borislava Pujic
- Klinika za Ginekologiju I Akuserstvo, Klinickog Centra Vojvodine, Novi Sad, Serbia
| | - Charles W Baysinger
- Department of Anesthesiology, University of Kentucky Medical Center, Lexington, KY, United States
| | - Curtis L Baysinger
- Division of Obstetric Anesthesia, Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, United States
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Riveros-Pérez E. Is it necessary to continue treating what was caused by one puncture with another one? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Riveros-Pérez E. ¿Es necesario seguir curando con una punción lo que se ocasionó con otra? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Is it necessary to continue treating what was caused by one puncture with another one?☆: ¿Es necesario seguir curando con una punción lo que se ocasionó con otra? COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201704000-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
Headache after dural puncture is a common complication accompanying neuraxial anesthesia. The proposed cause is loss of cerebrospinal fluid through the puncture into the epidural space. Although obstetric patients are at risk for the development of this headache because of female gender and young age, there is a difference in the obstetric population. Women who deliver by cesarean delivery have a lower incidence of headache after dural puncture compared with those who deliver vaginally. Treatment of postdural puncture headache is an epidural blood patch. Departments should develop protocols for management of accidental dural puncture, including appropriate follow-up and indications for further management.
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Affiliation(s)
- Robert R Gaiser
- Department of Anesthesiology, University of Kentucky, Lexington, KY 40506, USA.
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Kwak KH. Postdural puncture headache. Korean J Anesthesiol 2017; 70:136-143. [PMID: 28367283 PMCID: PMC5370299 DOI: 10.4097/kjae.2017.70.2.136] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 12/18/2022] Open
Abstract
Postdural puncture headache (PDPH) is a common complication after inadvertent dural puncture. Risks factors include female sex, young age, pregnancy, vaginal delivery, low body mass index, and being a non-smoker. Needle size, design, and the technique used also affect the risk. Because PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. A diagnostic hallmark of PDPH is a postural headache that worsens with sitting or standing, and improves with lying down. Conservative therapies such as bed rest, hydration, and caffeine are commonly used as prophylaxis and treatment for this condition; however, no substantial evidence supports routine bed rest and aggressive hydration. An epidural blood patch is the most effective treatment option for patients with unsuccessful conservative management. Various other prophylactic and treatment interventions have been suggested. However, due to a lack of conclusive evidence supporting their use, the potential benefits of such interventions should be weighed carefully against the risks. This article reviews the current literature on the diagnosis, risk factors, pathophysiology, prevention, and treatment of PDPH.
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Affiliation(s)
- Kyung-Hwa Kwak
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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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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Baratloo A, Rouhipour A, Forouzanfar MM, Safari S, Amiri M, Negida A. The Role of Caffeine in Pain Management: A Brief Literature Review. Anesth Pain Med 2016; 6:e33193. [PMID: 27642573 PMCID: PMC5018099 DOI: 10.5812/aapm.33193] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 10/17/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022] Open
Abstract
CONTEXT Caffeine is the most commonly used psychoactive legal drug in the world. Caffeine's role in controlling pain has received less attention in the past, yet is being increasingly considered. This article briefly reviewed the literature to clarify the role of caffeine as a drug for pain control and attract investigators to this topic. EVIDENCE ACQUISITION The data on Caffeine as an adjuvant therapy or as a main component for pain modulation has been narratively reviewed. RESULTS Caffeine plays an important role in pain modulation through their action on adenosine receptors which are involved in nociception. The use of caffeine as adjuvant treatment was well-established in the literature and caffeine is currently available in some over the counter medications. Studies showed controversial results about the interaction between caffeine and morphine for pain relief in patients with terminal stage cancer. As a main component for pain modulation, Caffeine can be used for hypnic headache and postdural puncture headache. CONCLUSIONS Caffeine has a potential role for pain modulation. Current evidence on caffeine use for migraine and terminal stage cancer is not well-established. Future studies should address the use of caffeine alone for different types of pain with dose escalation and standardization of outcome measurement.
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Affiliation(s)
- Alireza Baratloo
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Mehdi Forouzanfar
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Safari
- Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Amiri
- Department of Emergency Medicine, Shahid Beheshti Hospital, Guilan University of Medical Sciences, Anzali, Iran
| | - Ahmed Negida
- Student Research Unit, Zagazig University, Zagazig, Egypt
- Corresponding author: Ahmed Negida, Student Research Unit, Zagazig University, Zagazig, Egypt. Tel: +20-1150333699; +20-1125549087, E-mail:
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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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Zeger W, Younggren B, Smith L. Comparison of cosyntropin versus caffeine for post-dural puncture headaches: A randomized double-blind trial. World J Emerg Med 2014; 3:182-5. [PMID: 25215060 DOI: 10.5847/wjem.j.issn.1920-8642.2012.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 06/28/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cosyntropin has been reported to be effective in the treatment of post-dural puncture headaches, but there is a lack of data on its effectiveness. We compared the efficacy of cosyntropin with that of caffeine in the treatment of post-dural puncture headaches. METHODS We performed an interim analysis of a prospective, double blinded, trial of adult patients presenting to the emergency department with a post-dural puncture headache. Patients were randomized to receive either intravenous caffeine or intravenous cosyntropin. Values on a 100-mm visual analog scale (VAS) were recorded at 0, 60, and 120 minutes to assess pain. Rescue therapy was documented on the study data forms. Its effectiveness was determined by the need for this therapy. RESULTS Thirty-seven patients were included and four patients were excluded from the analysis because of protocol violations or incomplete data. Analysis was based on intention-to-treat. Caffeine was 80% (95% CI 60-100%) effective and cosyntropin was 56% (95% CI 33-79%) effective in treating post-dural puncture headaches. The group's VAS scores at 0, 60, and 120 minutes were 80 mm, 41 mm, 31 mm for caffeine and 80 mm, 40 mm, 33 mm for cosyntropin, respectively (P=0.66). CONCLUSION Caffeine was not more effective than cosyntropin in treating patients with post-dural puncture headaches, and there was no difference in the degree of pain relief on VAS assessment.
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Affiliation(s)
- Wesley Zeger
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Bradley Younggren
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA, USA
| | - Lynette Smith
- Department of Emergency Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
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López-Herranz P. Análisis de la frecuencia de cefalea pospunción de la duramadre y tratamiento más común en el Hospital General de México. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2014. [DOI: 10.1016/j.hgmx.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Nguyen DT, Walters RR. Standardizing Management of Post-Dural Puncture Headache in Obstetric Patients: A Literature Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojanes.2014.410037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Faridi Tazeh-Kand N, Eslami B, Ghorbany Marzony S, Abolhassani R, Mohammadian K. Injection of intrathecal normal saline in decreasing postdural puncture headache. J Anesth 2013; 28:206-9. [PMID: 23903901 DOI: 10.1007/s00540-013-1683-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Postdural puncture headache (PDPH) is the most common and still unresolved postoperative complication of spinal anesthesia. Although there are several positive results of intrathecal saline injection for the treatment of PDPH and prophylaxis after accidental dural puncture, the effect of deliberate intrathecal saline injection before spinal anesthesia has not been examined. The objective of our study was to evaluate the effect of prophylactic administration of intrathecal normal saline in decreasing PDPH. METHODS One hundred healthy women (ASA physical status I) of age between 18 and 35 years scheduled for elective term cesarean delivery under spinal anesthesia were included. Patients were randomly divided into two equal groups. Group C received 2.5 ml (12.5 mg) hyperbaric bupivacaine 0.5 % as a control, and group S received intrathecal normal saline 5 ml before intrathecal injection of 2.5 ml (12.5 mg) hyperbaric bupivacaine 0.5%. The incidence and severity of PDPH were assessed after 48 h and again 3-7 days after operation. RESULTS Basal characteristics were statistically similar in both groups (P > 0.05). The incidences of moderate and severe PDPH during first postoperative 48 h were not different between the groups (P = 0.24). However, the frequency of PDPH after 3-7 days was statistically higher in group C in compared with group S (16 vs. 2 %, P = 0.03). Totally the frequency of PDPH was higher in group C (24 vs. 2%, P = 0.002). CONCLUSION Administration of normal saline (5 ml) before intrathecal administration of hyperbaric bupivacaine as a preventive approach is an effective and simple way to minimize PDPH in patients undergoing cesarean section.
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Affiliation(s)
- Nasrin Faridi Tazeh-Kand
- Department of Anesthesiology, Arash Women's Hospital, Tehran University of Medical Sciences, Rashid Ave., Resalat Highway, P.O. Box: 1653915981, Tehranpars, Tehran, Iran,
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[Post-dural puncture headache and blood-patch: theoretical and practical approach]. ACTA ACUST UNITED AC 2013; 32:325-38. [PMID: 23566592 DOI: 10.1016/j.annfar.2013.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 02/11/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To review the current research and formulate a rational approach to the physiopathology, cause and treatment of post-dural puncture headache (PDPH). DATA SOURCES Articles published to December 2011 were obtained through a search of Medline for the MeSh terms "epidural blood-patch" and "post-dural puncture headache". STUDY SELECTION Six hundred and eighty-two pertinent studies were included and 200 were analysed. DATA SYNTHESIS Resulting of a dural tap after spinal anaesthesia or diagnostic lumbar puncture or as a complication of epidural anaesthesia, PDPH occurs when an excessive leak of cerebrospinal fluid leads to intracranial hypotension associated to a resultant cerebral vasodilatation. Reduction in cerebrospinal fluid volume in upright position may cause traction of the intracranial structure and stretching of vessels. Typically postural, headache may be associated to nausea, photophobia, tinnitus or arm pain and changes in hearing acuity. In severe cases, there may be cranial nerve dysfunction and nerve palsies secondary to traction on those nerves. The Epidural Blood-Patch (EBP) is considered as the "gold standard" in the treatment of PDHP because it induces a prolonged elevation of subarachnoid and epidural pressures, whereas such elevation is transient with saline or dextran. EBP should be performed within 24-48hours of onset of headache; the optimum volume of epidural blood appears to be 15-20mL. Severe complications following EBP are exceptional. The use of echography may be safety puncture. The optimum timing of epidural blood-patch, the resort of repeating procedure if the symptomatology does not disappear, the alternative to the conventional medical treatment need to be determined by future clinical trial.
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Wagner Y, Storr F, Cope S. Gabapentin in the treatment of post-dural puncture headache: a case series. Anaesth Intensive Care 2012; 40:714-8. [PMID: 22813502 DOI: 10.1177/0310057x1204000420] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Gabapentin has been reported to be useful in the management of epilepsy, neuropathic pain and post-dural puncture headache. Seventeen obstetric cases are presented in which gabapentin was used either as a primary therapy for the management of severe headache following a diagnosed dural puncture or as an analgesic adjunct in patients with dural puncture headache unresponsive to epidural blood patch. In our patients, analgesic therapy was essential to enable care of their newborns as other management options had failed or were unavailable. In nine patients we observed an excellent result with reduction of headache severity within 24 hours. Gabapentin appears potentially beneficial in the management of patients with post-dural puncture headaches.
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Affiliation(s)
- Y Wagner
- National Women's Anaesthetics, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand.
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Amorim JA, Gomes de Barros MV, Valença MM. Post-dural (post-lumbar) puncture headache: risk factors and clinical features. Cephalalgia 2012; 32:916-23. [PMID: 22843225 DOI: 10.1177/0333102412453951] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This is an analytic, interventional, cross sectional study to evaluate the risk factors of post-dural (post-lumbar) puncture headache (PDPH) and the validity of the diagnostic criteria for PDPH from the ICHD II. METHODS Six-hundred-and-forty patients (332 non-pregnant women and 308 men) aged 8-65 years underwent spinal anesthesia with Quincke 25G or 27G needles in elective surgery. RESULTS Forty-eight (7.5%) of the patients developed PDPH. The binary logistic regression analysis identified as risk factors: gender [11.1% female vs. 3.6% male, OR 2.25 (1.07-4.73); p = 0.03], age [11.0% 31-50 years of age vs. 4.2% others, OR 2.21 (1.12-4.36); p = 0.02], previous history of PDPH [26.4% positive vs. 6.2% negative, OR 4.30 (1.99-9.31); p < 0.01] and bevel orientation [16.1% perpendicular vs. 5.7% parallel, OR 2.16 (1.07-4.35); p = 0.03]. The period of latency between lumbar puncture and headache onset range from 6 to 72 hours and the duration from 3 to 15 days. In 34/48 (71%) patients with PDPH, at least one of the following was present: neck stiffness, tinnitus, hypoacusia, photophobia, or nausea. CONCLUSION In conclusion, 14/48 patients (29%) suffered none of the above-mentioned symptoms, indicating that a significant number of patients may suffer from PDPH in the absence of any symptoms apart from the headache itself. This suggests that a further analyses of existing studies should be made to determine if a criteria change may need consideration.
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López Correa T, Sánchez Montero FJ, Garzón Sánchez JC, Muriel Villoria C. [Reply to the article "Comments on the article Postdural puncture headache in obstetrics"]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:226-227. [PMID: 22554984 DOI: 10.1016/j.redar.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/15/2012] [Indexed: 05/31/2023]
Affiliation(s)
- T López Correa
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Salamanca, Salamanca, España
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Paech M. Iatrogenic headaches: giving everyone a sore head. Int J Obstet Anesth 2012; 21:1-3. [DOI: 10.1016/j.ijoa.2011.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/10/2011] [Indexed: 11/28/2022]
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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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Straube A, Aicher B, Fiebich BL, Haag G. Combined analgesics in (headache) pain therapy: shotgun approach or precise multi-target therapeutics? BMC Neurol 2011; 11:43. [PMID: 21453539 PMCID: PMC3080296 DOI: 10.1186/1471-2377-11-43] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 03/31/2011] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pain in general and headache in particular are characterized by a change in activity in brain areas involved in pain processing. The therapeutic challenge is to identify drugs with molecular targets that restore the healthy state, resulting in meaningful pain relief or even freedom from pain. Different aspects of pain perception, i.e. sensory and affective components, also explain why there is not just one single target structure for therapeutic approaches to pain. A network of brain areas ("pain matrix") are involved in pain perception and pain control. This diversification of the pain system explains why a wide range of molecularly different substances can be used in the treatment of different pain states and why in recent years more and more studies have described a superior efficacy of a precise multi-target combination therapy compared to therapy with monotherapeutics. DISCUSSION In this article, we discuss the available literature on the effects of several fixed-dose combinations in the treatment of headaches and discuss the evidence in support of the role of combination therapy in the pharmacotherapy of pain, particularly of headaches. The scientific rationale behind multi-target combinations is the therapeutic benefit that could not be achieved by the individual constituents and that the single substances of the combinations act together additively or even multiplicatively and cooperate to achieve a completeness of the desired therapeutic effect.As an example the fixed-dose combination of acetylsalicylic acid (ASA), paracetamol (acetaminophen) and caffeine is reviewed in detail. The major advantage of using such a fixed combination is that the active ingredients act on different but distinct molecular targets and thus are able to act on more signalling cascades involved in pain than most single analgesics without adding more side effects to the therapy. SUMMARY Multitarget therapeutics like combined analgesics broaden the array of therapeutic options, enable the completeness of the therapeutic effect, and allow doctors (and, in self-medication with OTC medications, the patients themselves) to customize treatment to the patient's specific needs. There is substantial clinical evidence that such a multi-component therapy is more effective than mono-component therapies.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, Klinikum Großhadern, Ludwig-Maximilians-University, D-81377 Munich, Germany
| | - Bernhard Aicher
- Boehringer Ingelheim Pharma GmbH&Co. KG, Binger-Str. 173, D-55216 Ingelheim am Rhein, Germany
| | - Bernd L Fiebich
- Dept. of Psychiatry and Psychotherapy, Universitätsklinikum Freiburg, Hauptstr. 5, D-79104 Freiburg, Germany
| | - Gunther Haag
- Michael-Balint Klinik, Hermann-Voland Str. 10, D-78126 Königsfeld im Schwarzwald, Germany
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López Correa T, Garzón Sánchez J, Sánchez Montero F, Muriel Villoria C. Cefalea postpunción dural en obstetricia. REVISTA ESPAÑOLA DE ANESTESIOLOGÍA Y REANIMACIÓN 2011; 58:563-73. [PMID: 22279876 DOI: 10.1016/s0034-9356(11)70141-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Darvish B, Gupta A, Alahuhta S, Dahl V, Helbo-Hansen S, Thorsteinsson A, Irestedt L, Dahlgren G. Management of accidental dural puncture and post-dural puncture headache after labour: a Nordic survey. Acta Anaesthesiol Scand 2011; 55:46-53. [PMID: 21039355 DOI: 10.1111/j.1399-6576.2010.02335.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND a major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post-dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries. METHODS a postal questionnaire was sent to the anaesthesiologist responsible for Obstetric anaesthesia service in all maternity units (n=153) with questions relating to the year 2008. RESULTS the overall response rate was 93%. About 32% (22-47%) of parturients received epidural analgesia for labour. There were databases for registering obstetric epidural complications in 13% of Danish, 24% of Norwegian and Swedish, 43% of Finnish and 100% of hospitals in Iceland. The estimated incidence of ADP was 1% (n approximately 900). Epidural blood patch (EBP) was performed in 86% (n≈780) of the parturients. The most common time interval from diagnosis to performing EBP was 24-48 h. The success rate for EBP was >75% in 67% (62-79%) of hospitals. The use of diagnostic CT/MRI before the first or the second EBP was exceptional. No major complication was reported. Teaching of epidurals was commonest (86%) in the non-obstetric population and 53% hospitals desired a formal training programme in obstetric analgesia. CONCLUSION we found the incidence of ADP to be approximately 1%. EBP was the commonest method used for its management, and the success rate was high in most hospitals. Formal training in epidural analgesia was absent in most countries and trainees first performed it in the non-obstetric population.
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Affiliation(s)
- B Darvish
- Department of Anesthesia and Intensive Care, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden.
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Abstract
Over decades, anesthesiologists have used intravenous adenosine as mainstay therapy for diagnosing or treating supraventricular tachycardia in the perioperative setting. More recently, specific adenosine receptor therapeutics or gene-targeted mice deficient in extracellular adenosine production or individual adenosine receptors became available. These models enabled physicians and scientists to learn more about the biologic functions of extracellular nucleotide metabolism and adenosine signaling. Such functions include specific signaling effects through adenosine receptors expressed by many mammalian tissues; for example, vascular endothelia, myocytes, hepatocytes, intestinal epithelia, or immune cells. At present, pharmacological approaches to modulate extracellular adenosine signaling are evaluated for their potential use in perioperative medicine, including attenuation of acute lung injury; renal, intestinal, hepatic and myocardial ischemia; or vascular leakage. If these laboratory studies can be translated into clinical practice, adenosine receptor-based therapeutics may become an integral pharmacological component of daily anesthesiology practice.
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Diener HC, Johansson U, Dodick DW. Headache attributed to non-vascular intracranial disorder. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:547-587. [PMID: 20816456 DOI: 10.1016/s0072-9752(10)97050-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This chapter deals with non-vascular intracranial disorders resulting in headache. Headache attributed to high or low cerebrospinal fluid pressure is separated into headache attributed to idiopathic intracranial hypertension (IIH), headache attributed to intracranial hypertension secondary to metabolic, toxic, or hormonal causes, headache attributed to intracranial hypertension secondary to hydrocephalus, post-dural puncture headache, cerebrospinal fluid (CSF) fistula headache, headache attributed to spontaneous (or idiopathic) low CSF pressure. Headache attributed to non-infectious inflammatory disease can be caused by neurosarcoidosis, aseptic (non-infectious) meningitis or lymphocytic hypophysitis. Headache attributed to intracranial neoplasm can be caused by increased intracranial pressure or hydrocephalus caused by neoplasm or attributed directly to neoplasm or carcinomatous meningitis. Other causes of headache include hypothalamic or pituitary hyper- or hyposecretion and intrathecal injection. Headache attributed to epileptic seizure is separated into hemicrania epileptica and post-seizure headache. Finally headache attributed to Chiari malformation type I (CM1) and the syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) are described.
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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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Abstract
PURPOSE OF REVIEW The treatment of postdural puncture headache remains controversial, largely because it is insufficiently evidence based. With high rates of neuraxial block in the obstetric population likely to continue, postdural puncture headache will remain a primary cause of morbidity and increased duration of hospital stay. This review describes new reports of relevance published in 2006 and until October 2007. RECENT FINDINGS New evidence justifies epidural blood patch as the treatment of choice for severe postdural puncture headache, but technical aspects such as optimal timing and volume are less clear. Symptomatic medical management remains diverse, with a multitude of therapies often advocated, despite a lack of scientific support. Reports of misdiagnosis and of complications associated with postdural puncture headache and its treatment emphasize the importance of multidisciplinary management and additional investigation, including radiological imaging, when the clinical picture warrants. SUMMARY The key reports in this epoch have shed light on the benefits of careful assessment of postpartum headache and treatment with an epidural blood patch. New management paradigms have been suggested and serious complications continue to be reported.
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