Meningeal (Postdural) Puncture Headache, Unintentional Dural Puncture, and the Epidural Blood Patch

2009 ◽  
Vol 34 (5) ◽  
pp. 430-437 ◽  
Author(s):  
Brian E. Harrington ◽  
Andrew M. Schmitt
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Postdural Puncture Headache ◽  
Blood Patch

scholarly journals Targeted Transforaminal Epidural Blood Patch for Postdural Puncture Headache in Patients with Postlaminectomy Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Yu Na Choi ◽  
Sang Ji Kang ◽  
Jin Deok Joo ◽  
Yu Mi Kim ◽  
Jang Hyeok In ◽  
...  
Keyword(s):  
Gold Standard ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Therapeutic Option ◽  
Severe Headache ◽  
Low Back ◽  
Postdural Puncture Headache ◽  
Lower Back ◽  
Interlaminar Approach ◽  
Blood Patch

Postdural puncture headache is a leak of cerebrospinal fluid that lowers intracranial pressure and usually presents as a positional headache. If conservative treatments are not successful, the epidural blood patch is the gold standard of the treatment for dural puncture. The interlaminar approach is the most commonly used technique for an epidural blood patch. This case report describes a patient who was treated with a transforaminal epidural blood patch for postdural puncture headache following an acupuncture procedure on his lower back after two epidural blood patches using an interlaminar approach had failed. The patient underwent an acupuncture therapy for management of chronic low back pain due to postlaminectomy syndrome. After the procedure, the patient had a severe headache and the conservative treatment was not effective. The two interlaminar epidural blood patches at the L2–3 level and at the L3–4 level were failed. We performed transforaminal epidural blood patch at the L3–4 and L4–5 levels on the left side, the site of leakage in the MRI myelogram. His symptoms finally subsided without complication. This case demonstrates that targeted transforaminal epidural blood patch is a therapeutic option for the treatment of postdural puncture headache when epidural blood patch using an interlaminar approach is ineffective.

Preliminary findings and outcomes associated with the use of a continuous spinal protocol for labor pain relief following accidental dural puncture

2019 ◽  
pp. rapm-2019-100544
Author(s):  
Marcos Izquierdo ◽  
Xiao-Feng Wang ◽  
Karl Wagner III ◽  
Cristian Prada ◽  
Augusto Torres ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Group Versus ◽  
Labor Pain ◽  
Postdural Puncture Headache ◽  
Epidural Group ◽  
Pain Scores ◽  
Blood Patch ◽  
Accidental Dural Puncture ◽  
Spinal Group

BackgroundVarious interventions have shown promise in reducing complications following accidental dural puncture. However, these have yet to be studied as a single, comprehensive protocol. The aim of this study is to compare outcomes associated with the use of a continuous spinal protocol for labor pain relief versus resiting the epidural catheter following accidental dural puncture.MethodsWe reviewed the charts of patients managed via our continuous spinal protocol and compared this group with patients for whom the epidural was resited following accidental dural puncture during the 5-year period prior to implementing our protocol. We assessed incidence of postdural puncture headache, epidural blood patch, frequency of catheter replacement, use of pressors, verbal pain scores at 0, 1, 2, 3, 4 hours following catheter placement, infection rates (meningitis/epidural abscess) and mode of delivery.ResultsThere were 129 women in the continuous spinal protocol group and 52 in the resited epidural group. The incidence of postdural puncture headache was lower in the continuous spinal group versus the resited epidural group (21.7% vs 67.3%, p<0.001), and the incidence of epidural blood patch was lower in the continuous spinal group versus the resited epidural group (12.4% vs 50.0%, p<0.001). Verbal pain scores were consistently lower in the continuous spinal group compared with the resited epidural group at all time intervals studied.ConclusionPatients managed via this continuous spinal protocol had significantly lower incidence of postdural puncture headache and epidural blood patch with more effective labor analgesia following accidental dural puncture.

scholarly journals Incidence of Postdural Puncture Headache after Caesarean Section Comparison Between 25G and 27G Quincke Variety of Spinal Needle

KYAMC Journal ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 762-769
Author(s):  
Md Afzalur Rahman ◽  
ABM Muksudul Alam ◽  
Muhammad Alamgir Mandal ◽  
Mostofa Kamruzzaman ◽  
Md Asraful Kabir ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Spinal Needle ◽  
Postdural Puncture Headache ◽  
Post Dural Puncture Headache ◽  
Group I ◽  
Blood Patch ◽  
Group Ii

Background: Post dural puncture headache is related to the size as well as type of the spinal needle used90. It is progressively reduced with the use of thinner Quincke type spinal needles.Objective: This was a Quasi-experimental study to compare the incidence of post dural puncture headache after caesarian section with spinal anaesthesia by two typys of needles named 25G and 27G Quincke varities.Methods: This study was conducted in the Department of Anaesthesiology of Shaheed Shurawardy Medical College Hospital, Dhaka. A total number of 60 adult patients with ASA physical status I & II scheduled for elective surgical caesarian section under spinal anaesthesia were enrolled in this study. Patients were randomly allocated equally, 30 in each group into two groups I and II. Patients of Group I, II received 25G and 27G quincke variety of spinal needle respectively. The randomization was double blind except for the anaesthetist performing spinal block. Patient, surgeon and the assessor in the ward was aware of the study. Spinal anaesthesia was performed with 2.0-2.5 ml 0.5% hyperbaric bupivacaine using 25G Quincke spinal needle (Group I),and 27G Quincke spinal needle (Group II) at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Incidence and severity of postdural puncture headache (PDPH) was recorded.Result: Seven (7) out of 60 patients developed PDPH giving an overall frequency of 11.6% (Table-2). Frequency of PDPH was 16.7% (5/30) in Group I, 6.7% (2/30) in Group II. In Group I, PDPH was mild in 3 patients (60%), moderate in 1 patient (20%) and severe in 1 patient (20%). In Group II, it was mild in 2 (100%), moderate in 0 and severe in 0 patient. Moderate and Severe PDPH was not observed with 27G Quincke spinal needle (Group II). None of the 60 patients with PDPH required an epidural blood patch. Symptoms were relieved by conventional means in all patients.Conclusion: In current practice epidural blood patch has the highest cure rate for management of PDPH and is usually very well tolerated by majority of patients. Overall, we concluded that when performing spinal anaesthesia for Caesarean section, 27G Quincke spinal needle has definite advantage over 25G Quincke spinal needles as far as frequency and severity of PDPH is concerned. Therefore we recommend routine use of the 27G Quincke spinal needle when performing spinal anaesthesia for Caesarean section.KYAMC Journal Vol. 7, No.-2, Jan 2017, Page 762-769

Accidental dural puncture, postdural puncture headache, intrathecal catheters, and epidural blood patch: revisiting the old nemesis

2013 ◽  
Vol 28 (4) ◽  
pp. 628-630 ◽  
Author(s):  
Roland Kaddoum ◽  
Faisal Motlani ◽  
Romeo N. Kaddoum ◽  
Arvi Srirajakalidindi ◽  
Deepak Gupta ◽  
...  
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Postdural Puncture Headache ◽  
Blood Patch ◽  
Accidental Dural Puncture

scholarly journals Cosyntropin for Prophylaxis against Postdural Puncture Headache after Accidental Dural Puncture

2010 ◽  
Vol 113 (2) ◽  
pp. 413-420 ◽  
Author(s):  
Sameh Michel Hakim
Keyword(s):  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Control Group ◽  
Postdural Puncture Headache ◽  
Kaplan Meier ◽  
Significant Prolongation ◽  
Group I ◽  
Blood Patch ◽  
Accidental Dural Puncture ◽  
Group 5

Background The aim of the current study was to investigate the effect of administration of cosyntropin after accidental dural puncture (ADP) on the incidence of postdural puncture headache (PDPH) and the need for therapeutic epidural blood patch (EBP). Methods Ninety parturients who suffered an ADP were studied. After delivery, patients were randomly assigned to one of two equal-sized groups. In group I (cosyntropin group), patients received cosyntropin in a dose of 1 mg intravenously. In group II (control group), patients received an equal volume of normal saline. Results Fifteen patients (33%) in the cosyntropin group suffered from PDPH, compared with 31 patients (68.9%) in the control group (P = 0.001). Significantly fewer patients in the cosyntropin group required an EBP, compared with the control group (5 patients [11.1%] vs. 13 patients [28.9%], respectively; P = 0.035). The Kaplan-Meier curves for the occurrence of PDPH showed a hazard ratio of 0.32 (95% CI = 0.16-0.55, P &lt; 0.0001). The time from ADP to occurrence of PDPH was significantly longer in the cosyntropin group (27.2 [7.7] h) in comparison with the control group (17.5 [4.9] h; P &lt; 0.001). However, there were no statistically significant differences among patients who developed PDPH in both groups with regard to the severity or duration of PDPH or with regard to the need for EBP or for repeat EBP (P &gt; 0.05). Conclusions Administration of cosyntropin after ADP in parturients was associated with significant reduction in the incidence of PDPH and need for EBP and significant prolongation of the time from ADP to occurrence of PDPH.

scholarly journals Comparisons of clinical characteristics, brain MRI findings, and responses to epidural blood patch between spontaneous intracranial hypotension and post-dural puncture headache: retrospective study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gha-Hyun Lee ◽  
Jiyoung Kim ◽  
Hyun-Woo Kim ◽  
Jae Wook Cho
Keyword(s):  
Intracranial Hypotension ◽  
Dural Puncture ◽  
Epidural Blood Patch ◽  
Brain Mri ◽  
Spontaneous Intracranial Hypotension ◽  
Vein Of Galen ◽  
Mri Findings ◽  
Post Dural Puncture Headache ◽  
Straight Sinus ◽  
Blood Patch

Abstract Background Spontaneous intracranial hypotension and post-dural puncture headache are both caused by a loss of cerebrospinal fluid but present with different pathogeneses. We compared these two conditions concerning their clinical characteristics, brain imaging findings, and responses to epidural blood patch treatment. Methods We retrospectively reviewed the records of patients with intracranial hypotension admitted to the Neurology ward of the Pusan National University Hospital between January 1, 2011, and December 31, 2019, and collected information regarding age, sex, disease duration, hospital course, headache intensity, time to the appearance of a headache after sitting, associated phenomena (nausea, vomiting, auditory symptoms, dizziness), number of epidural blood patch treatments, and prognosis. The brain MRI signs of intracranial hypotension were recorded, including three qualitative signs (diffuse pachymeningeal enhancement, venous distention of the lateral sinus, subdural fluid collection), and six quantitative signs (pituitary height, suprasellar cistern, prepontine cistern, mamillopontine distance, the midbrain-pons angle, and the angle between the vein of Galen and the straight sinus). Results A total of 105 patients (61 spontaneous intracranial hypotension patients and 44 post-dural puncture headache patients) who met the inclusion criteria were reviewed. More patients with spontaneous intracranial hypotension required epidural blood patch treatment than those with post-dural puncture headache (70.5% (43/61) vs. 45.5% (20/44); p = 0.01) and the spontaneous intracranial hypotension group included a higher proportion of patients who underwent epidural blood patch treatment more than once (37.7% (23/61) vs. 13.6% (6/44); p = 0.007). Brain MRI showed signs of intracranial hypotension in both groups, although the angle between the vein of Galen and the straight sinus was greater in the post-dural puncture headache group (median [95% Confidence Interval]: 85° [68°-79°] vs. 74° [76°-96°], p = 0.02). Conclusions Patients with spontaneous intracranial hypotension received more epidural blood patch treatments and more often needed multiple epidural blood patch treatments. Although both groups showed similar brain MRI findings, the angle between the vein of Galen and the straight sinus differed significantly between the groups.

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