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Uppal V, Russell R, Sondekoppam RV, Ansari J, Baber Z, Chen Y, DelPizzo K, Dirzu DS, Kalagara H, Kissoon NR, Kranz PG, Leffert L, Lim G, Lobo C, Lucas DN, Moka E, Rodriguez SE, Sehmbi H, Vallejo MC, Volk T, Narouze S. Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group. Reg Anesth Pain Med 2024; 49:471-501. [PMID: 37582578 DOI: 10.1136/rapm-2023-104817] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Postdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH. METHODS Based on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach. RESULTS Based on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence. CONCLUSIONS These clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients' interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.
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Affiliation(s)
- Vishal Uppal
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robin Russell
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rakesh V Sondekoppam
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Jessica Ansari
- Anesthesia Department, Stanford Health Care, Stanford, California, USA
| | - Zafeer Baber
- Department of Anesthesiology and Perioperative Medicine, Newton-Wellesley Hospital, Newton, Massachusetts, USA
| | - Yian Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, California, USA
| | - Kathryn DelPizzo
- Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Dan Sebastian Dirzu
- Anesthesia and Intensive Care, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Hari Kalagara
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Narayan R Kissoon
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter G Kranz
- Depatement of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Lisa Leffert
- Department of Anesthesiology, Yale New Haven Health System; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Grace Lim
- Department of Anesthesiology & Perioperative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Obstetrics & Gynecology, Magee Womens Hospital of UPMC, Pittsburgh, Pennsylvania, USA
| | - Clara Lobo
- Anesthesiology Institute, Interventional Pain Medicine Department, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Dominique Nuala Lucas
- Department of Anaesthesia, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Eleni Moka
- Department of Anaesthesiology, Creta Interclinic Hospital - Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Stephen E Rodriguez
- Department of Anesthesia, Walter Reed Army Medical Center, Bethesda, Maryland, USA
| | - Herman Sehmbi
- Department of Anesthesia, Western University, London, Ontario, Canada
| | - Manuel C Vallejo
- Departments of Medical Education, Anesthesiology, Obstetrics & Gynecology, West Virginia University, Morgantown, West Virginia, USA
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Samer Narouze
- Northeast Ohio Medical University, Rootstown, Ohio, USA
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, OH, USA
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Alseoudy MM, Abd-Elmoaty WA, Ramzy EA, Abdelbaser I, El-Emam ESM. Ultrasound-Guided Suprazygomatic Sphenopalatine Ganglion Block for Postdural Puncture Headache Resistant to Epidural Blood Patch: A Case Report. A A Pract 2024; 18:e01778. [PMID: 38572887 DOI: 10.1213/xaa.0000000000001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
Even though epidural blood patch (EBP) is thought to be the definitive treatment for severe cases of postdural puncture headache (PDPH), it may be accompanied by complications like adhesion arachnoiditis, and cauda equina syndrome, especially if the injection is repeated. The sphenopalatine ganglion (SPG) block is a new minimally invasive technique for the treatment of PDPH, with variable results according to the clinical situation and deployed approach. We describe a case of PDPH resistant to EBP in which we successfully managed symptoms using ultrasound-guided suprazygomatic SPG block to deliver local anesthetic directly into pterygopalatine fossa, thus avoiding a second EBP.
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Affiliation(s)
- Mahmoud M Alseoudy
- From the Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Wael A Abd-Elmoaty
- Department of Anesthesia, Sherbeen General Hospital, Ministry of Health, Sherbeen, Egypt
| | - Eiad A Ramzy
- From the Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ibrahim Abdelbaser
- From the Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - El-Sayed M El-Emam
- From the Department of Anesthesia, Surgical Intensive Care, and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Lawrence H, Morton A. Postpartum complications following neuraxial anaesthesia for obstetric physicians. Obstet Med 2023; 16:142-150. [PMID: 37720002 PMCID: PMC10504890 DOI: 10.1177/1753495x221146329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 12/04/2022] [Indexed: 09/19/2023] Open
Abstract
Neuraxial analgesia and anaesthesia are widely accepted and well-tolerated modes of delivery analgesia, being employed in up to 76% of vaginal deliveries and 94% of caesarean deliveries in the United States.1 A cause of considerable concern for postpartum women, their family and caring health professionals is the occurrence of unexplained postpartum complications, not only for management in the index pregnancy, but the uncertain risk of recurrence in future pregnancies. Complications of neuraxial blocks may impact significantly on the ability of mothers to care for and bond with their newborn. The reported incidence of temporary neurological deficit following obstetric neuraxial blocks is 1 in 3900 procedures, and the risk of permanent neurological harm estimated to be between 1 in 80,000 and 1 in 320,425 procedures.2 Obstetric physicians may be asked to review women with postpartum complications following neuraxial blocks. This article reviews complications that may be seen following neuraxial blocks for delivery.
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Affiliation(s)
- Heather Lawrence
- Obstetrics Department, Mater Health, Raymond Terrace, South Brisbane, Australia
| | - Adam Morton
- Obstetric Medicine, Mater Health, Raymond Terrace, South Brisbane, Australia
- Department of Medicine, University of Queensland, Herston, Australia
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Zhou Y, Geng Z, Song L, Wang D. Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture. Chin Med J (Engl) 2023; 136:88-95. [PMID: 36728556 PMCID: PMC10106202 DOI: 10.1097/cm9.0000000000001967] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. METHODS Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. RESULTS A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). CONCLUSIONS The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.
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Affiliation(s)
- Yin Zhou
- Department of Anesthesiology, Peking University First Hospital, Beijing 100034 China
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Zetlaoui PJ, Buchheit T, Benhamou D. Epidural blood patch: A narrative review. Anaesth Crit Care Pain Med 2022; 41:101138. [DOI: 10.1016/j.accpm.2022.101138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/01/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022]
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Hou Y, Liang H, Fan C, Liu R, Feng Y. Association of intraocular pressure and postoperative nausea and vomiting after microvascular decompression - a prospective cohort study. BMC Anesthesiol 2022; 22:132. [PMID: 35490219 PMCID: PMC9055703 DOI: 10.1186/s12871-022-01665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting is common in patients receiving microvascular decompression. In the current study, we examined whether postoperative nausea and vomiting is associated with reduced intraocular pressure (IOP) after microvascular decompression, a measure that reflects intracranial pressure. METHODS This is a prospective cohort study. Adult patients scheduled for microvascular decompression surgery for hemifacial spasm between January 2020 and August 2020 were eligible. IOP was measured immediately before anesthesia induction and 30 min after patients regained complete consciousness using non-contact tonometry. IOP reduction was defined by at least 1 mmHg decrease vs. preoperative baseline. The primary outcome was vomiting on postoperative day 1. RESULTS A total of 103 subjects were enrolled. IOP was reduced in 56 (54.4%) subjects. A significantly greater proportion of patients with IOP reduction had vomiting on postoperative day 1 (51.8% (29/56) vs. 23.4% (11/47) in those without IOP reduction; p = 0.003). In the multivariate regression analysis, vomiting on postoperative day 1 was associated with female sex [odds ratio = 7.87, 95% CI: 2.35-26.32, p = 0.001] and IOP reduction [odds ratio = 2.93, 95% CI: 1.13-7.58, p = 0.027]. CONCLUSIONS In patients undergoing microvascular decompression surgery, postoperative IOP reduction is associated with postoperative vomiting. TRIAL REGISTRATION Chinese Clinical Trial Registry: ChiCTR2000029083 . Registered 13 January 2020.
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Affiliation(s)
- Yuantao Hou
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Hansheng Liang
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Cungang Fan
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
| | - Ruen Liu
- Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
| | - Yi Feng
- Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
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Galanou P, Tsoleridis T, Tsoleridis S. Epidural Blood Patch Performed Immediately After Dural Puncture and Epidural Drug Administration. Cureus 2021; 13:e16634. [PMID: 34462675 PMCID: PMC8386135 DOI: 10.7759/cureus.16634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/18/2022] Open
Abstract
The epidural blood patch (EBP) is a solution for persistent headaches following an accidental dural puncture. We report three cases where EBP was performed immediately after dural puncture combined with drug administration for lumbago. To the best of our knowledge, no similar cases have been reported in the literature. The patients provided their informed consent, and all standard protocols were followed. At the moment of the dural puncture, all the patients manifested severe headaches, nausea, vomiting, and profuse sweating. A second epidural puncture was performed at a higher intervertebral space, followed by drug administration and 20 mL of autologous blood. All the patients improved gradually, while their headaches vanished after 30-35 minutes. The patients were kept in for monitoring and released the following day with specific instructions and daily phone contact for a week without any complications. Their lumbago symptoms regressed. The possibility of pneumocephalus was excluded because of the patients’ symptomatology. The risk of high or total spinal anesthesia due to local anesthetic leakage subarachnoidally was countered with close monitoring of the patients. EBP complications include failure, postdural-puncture headache worsening by an accidental additional dural tear(s), back pain, and infection. All patients were instructed to report any symptoms immediately. EBP executed immediately after dural puncture seems to relieve headache fast and does not appear to impede epidural analgesia.
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Affiliation(s)
- Polymnia Galanou
- Anesthesia and Pain Treatment Unit, General Hospital of Rhodes, Greece, Rhodes, GRC
| | - Theofilos Tsoleridis
- Anesthesia and Pain Treatment Unit, General Hospital of Rhodes, Greece, Rhodes, GRC
| | - Savvas Tsoleridis
- Anesthesia and Pain Treatment Unit, General Hospital of Rhodes, Greece, Rhodes, GRC
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Chazen JL, Amrhein TJ. Arachnoiditis following epidural blood patch-An avoidable rare complication due to blind technique. Headache 2021; 61:972-973. [PMID: 34184259 DOI: 10.1111/head.14145] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J Levi Chazen
- Department of Radiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Timothy J Amrhein
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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The impact of aminophylline on incidence and severity of post-dural puncture headache: A meta-analysis of randomised controlled trials. Anaesth Crit Care Pain Med 2021; 40:100920. [PMID: 34186265 DOI: 10.1016/j.accpm.2021.100920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND This meta-analysis aimed at addressing the impact of aminophylline use on risk and severity of post-dural puncture headache (PDPH). METHODS Electronic databases (i.e., Medline, Embase, and the Cochrane controlled trials register) were searched from inception to the 12th of January 2021 for randomised controlled trials (RCTs) that assessed the efficacy of aminophylline for treatment (i.e., primary outcome) or prophylaxis (i.e., secondary outcome) against PDPH in various clinical settings. The study is registered with PROSPERO (CRD42020207713). RESULTS A total of ten RCTs (n = 976) were included for analysis. Five studies (n = 270) revealed a lower pain score in patients with PDPH receiving aminophylline than that in the placebo group (standardised mean differences = -1.34, 95% confidence interval (CI): -1.76 to -0.91). In contrast, five trials (four on Caesarean sections and one on lower extremity surgeries, n = 706) demonstrated no prophylactic effect of aminophylline against PDPH at 24 [risk ratio (RR) = 0.70, 95% CI: 0.30-1.63, n = 637], 48 (RR = 0.48, 95% CI: 0.22-1.05, n = 506), and 72 (RR = 0.89, 95% CI: 0.54-1.48, n = 317) hours. Nevertheless, sensitivity analysis demonstrated significant prophylactic efficacy after removal of one study adopting a relatively low dose of aminophylline (RR = 0.36, 95% CI: 0.19-0.67). Most studies reported no increase in the incidence of adverse events associated with aminophylline use compared with that in the control group. CONCLUSION Our results indicated that aminophylline might be a reasonable alternative for treating PDPH. However, its use for prevention was not established in this meta-analysis and further large-scale studies are warranted to support this option.
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Hackert J, Maßmann L, Sure U, Forsting M, Kleinschnitz C, Pul R, Hagenacker T. Immunotherapies in chronic adhesive arachnoiditis - A case series and literature review. eNeurologicalSci 2021; 24:100350. [PMID: 34195394 PMCID: PMC8225987 DOI: 10.1016/j.ensci.2021.100350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 06/09/2021] [Indexed: 01/02/2023] Open
Abstract
Chronic spinal adhesive arachnoiditis (CSAA) is a rare condition with limited therapeutic options. Surgical treatment proves effective in approximately 60% of cases. Conservative treatment options have not been extensively investigated. Here, we report the course of the disease, analyze the effect of immune treatments in patients with CSAA who were treated in the University Hospital Essen between 2015 and 2020, and conduct a literature review. Three out of four patients showed no improvement after treatment with corticosteroids, methotrexate, or plasmapheresis. All non-responders suffered from CSAA for several years, while one patient who had a disease duration of less than one month fully recovered. It is necessary to verify whether treatment at an early stage of the disease is better than treatment after chronic adhesion manifestation, as it interrupts the development of adhesions and all subsequent complications. Surgical treatment of CSAA patients proves effective in approx. 60% of cases. High-dose steroid treatment may be effective in early stages of CSAA. Only conservative therapy cannot be recommended in long-standing CSAA.
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Affiliation(s)
- Jana Hackert
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Louisa Maßmann
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Ulrich Sure
- University Medicine Essen, Department of Neurosurgery and Spine Surgery, Hufelandstrasse 55, 45147 Essen, Germany
| | - Michael Forsting
- University Medicine Essen, Institute of Diagnostic and Interventional Radiology and Neuroradiology, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Kleinschnitz
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Refik Pul
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
| | - Tim Hagenacker
- University Medicine Essen, Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, Hufelandstrasse 55, 45147 Essen, Germany
- Corresponding author.
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Villani LA, Digre KB, Cortez MM, Bokat C, Rassner UA, Ozudogru SN. Arachnoiditis, a complication of epidural blood patch for the treatment of low‐pressure headache: A case report and systematic review. Headache 2021; 61:244-252. [DOI: 10.1111/head.14076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/05/2021] [Accepted: 01/09/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Linda A. Villani
- Department of Neurology University of Utah School of Medicine Salt Lake City UT USA
| | - Kathleen B. Digre
- Department of Neurology University of Utah School of Medicine Salt Lake City UT USA
- Division of Headache and Neuro‐Ophthalmology University of Utah School of Medicine Salt Lake City UT USA
| | - Melissa M. Cortez
- Department of Neurology University of Utah School of Medicine Salt Lake City UT USA
- Division of Diagnostic and Clinical Neurology University of Utah School of Medicine Salt Lake City UT USA
| | - Christina Bokat
- Division of Headache and Neuro‐Ophthalmology University of Utah School of Medicine Salt Lake City UT USA
- Department of Anesthesiology University of Utah School of Medicine Salt Lake City UT USA
| | - Ulrich A. Rassner
- Division of Neuroradiology Imaging University of Utah School of Medicine Salt Lake City UT USA
- Department of Radiology University of Utah School of Medicine Salt Lake City UT USA
| | - Seniha N. Ozudogru
- Department of Neurology University of Utah School of Medicine Salt Lake City UT USA
- Division of Headache and Neuro‐Ophthalmology University of Utah School of Medicine Salt Lake City UT USA
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Siegler BH, Gruß M, Oehler B, Keßler J, Fluhr H, Weis C, Schulz F, Weigand MA. [Intranasal lidocaine atomization as novel and noninvasive treatment option for postdural puncture headache : Two case reports from obstetric anesthesiology]. Anaesthesist 2020; 70:392-397. [PMID: 33301057 PMCID: PMC8099803 DOI: 10.1007/s00101-020-00900-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 11/16/2020] [Accepted: 11/16/2020] [Indexed: 01/25/2023]
Abstract
Hintergrund Der Postpunktionskopfschmerz („postdural puncture headache“ [PDPH]) stellt eine ernsthafte anästhesiologische Komplikation geburtshilflich behandelter Patientinnen dar. Führen konservativ-medikamentöse Therapieversuche nicht zu einer Symptomlinderung, empfehlen aktuelle Leitlinien die frühzeitige Durchführung eines epiduralen Blut-Patch. Als potenzielle Alternative wird die transnasale Blockade des Ganglion sphenopalatinum mittels Lokalanästhetika diskutiert. Methode In dieser Falldarstellung wird erstmals von einer Modifikation dieser Technik unter Anwendung eines Medikamentenzerstäubers („mucosal atomization device“ [MAD]) zur Therapie eines PDPH bei zwei geburtshilflichen Patientinnen berichtet. Über dieses Verfahren existieren bislang keine Erfahrungen aus der geburtshilflichen Anästhesiologie. Ergebnisse Die erste Patientin (25-jährige Zweitgravida, BMI 54,7 kg/m2) zeigte am ersten Tag nach Sectio caesarea in Spinalanästhesie einen ausgeprägten PDPH mit starker Übelkeit und Erbrechen. Bei der zweiten Patientin (32-jährige Drittgravida, BMI 27,3 kg/m2) kam es 4 Tage nach Spontanpartus unter Periduralanästhesie zu einer PDPH-bedingten Wiederaufnahme. Während konservative Maßnahmen sowie Therapieversuche mit Nichtopioidanalgetika und Koffein keinen hinreichenden Behandlungserfolg erzielten, führte die intranasale Lidocainapplikation mittels MAD zu einer unmittelbaren und persistierenden Linderung der Beschwerden. Von beiden Patientinnen wurde die Lidocaingabe sehr gut vertragen; sie konnten am Folgetag aus dem Krankenhaus entlassen werden. Schlussfolgerung Die vorgestellte nichtinvasive und einfach durchzuführende Maßnahme stellt eine wertvolle Ergänzung bisheriger Therapieoptionen und eine potenzielle Alternative zum epiduralen Blutpatch bei geburtshilflichen Patientinnen mit PDPH dar.
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Affiliation(s)
- Benedikt Hermann Siegler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland.
| | - Marco Gruß
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum Hanau GmbH, Leimenstraße 20, 63450, Hanau, Deutschland
| | - Beatrice Oehler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Jens Keßler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Herbert Fluhr
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Claudia Weis
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum Hanau GmbH, Leimenstraße 20, 63450, Hanau, Deutschland
| | - Frank Schulz
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
| | - Markus Alexander Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 420, 69120, Heidelberg, Deutschland
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Symptomatic Intrathecal Hematoma following an Epidural Blood Patch for an Obstetric Patient with Postdural Puncture Headache: A Case Report and Synthesis of the Literature. Case Rep Anesthesiol 2020; 2020:8925731. [PMID: 32257448 PMCID: PMC7104125 DOI: 10.1155/2020/8925731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
Epidural blood patch (EBP), generally considered a low-risk procedure, can potentially lead to significant neurological complications. We report the case of a parturient who underwent an uneventful EBP for postdural puncture headache (PDPH) and subsequently presented with progressively worsening radicular symptoms. Magnetic resonance imaging (MRI) revealed an intrathecal hematoma, and conservative management with steroids led to complete recovery. Our case highlights the possibility of this rare complication following an uneventful procedure and the importance of prompt diagnosis and treatment to prevent serious adverse outcomes. Literature review, EBP alternatives, and strategies to minimize complications following blood patch will be discussed in this report.
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