Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature

Advances in manufacturing technology have led to the wider availability and affordability of narrow gauge atraumatic spinal needles. The use of these needles is the most effective method available for anaesthetists to reduce the incidence of post dural puncture headache. Their use in all circumstances however, may not be appropriate in light of the problems which may be associated. These problems are illustrated here by four case reports and a review of the literature.

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Epidural blood patch for a post-dural puncture headache in a COVID-19 positive patient following labor epidural analgesia

International Journal of Obstetric Anesthesia ◽

10.1016/j.ijoa.2021.102970 ◽

2021 ◽

Vol 46 ◽

pp. 102970

Author(s):

M. Ibrahim ◽

R. Darling ◽

N. Oaks ◽

R. Babazade ◽

R. Vadhera

Keyword(s):

Epidural Analgesia ◽

Dural Puncture ◽

Epidural Blood Patch ◽

Positive Patient ◽

Post Dural Puncture Headache ◽

Blood Patch ◽

Labor Epidural

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Factors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, NigeriaFactors associated with demand for epidural analgesia among women in labor at a tertiary hospital in Nnewi, South-East, Nigeria

10.30574/msarr.2021.2.1.0028 ◽

2021 ◽

Vol 2 (1) ◽

pp. 08-013

Author(s):

Samuel C Ojiakor ◽

Afam B Obidike ◽

Kenneth N Okeke ◽

Chioma P Nnamani ◽

Amaka L Obi-Nwosu ◽

...

Keyword(s):

Epidural Analgesia ◽

Dural Puncture ◽

Univariate Analysis ◽

Mode Of Delivery ◽

Tertiary Hospital ◽

Labor Analgesia ◽

University Teaching ◽

P Value ◽

Post Dural Puncture Headache ◽

Labor Epidural

Background: Epidural labor analgesia has become prevalent in high income countries, but its use in low and middle income countries such as Nigeria is poorly studied. Objectives: To determine the rate of demand, indications, post-dural puncture headache rate and factors affecting demand for epidural analgesia among women in labor. Method: This was a across sectional analytical study of women in labor who were managed at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria from 1st January 2017 to 31st December 2017. Data was obtained from women’s case files from Medical record department, labor ward, and Anesthesiology departmental records. Information obtained included total number of deliveries, mode of delivery, those that received epidural: date and time of placement, indication and number of side effects. Univariate analysis models were applied to evaluate the association between patient demographic, socioeconomic factors, clinical and demand for labor epidural analgesia. A p-value of <0.05 was taken as significant. Results: Thirty-six women out of 1,373 women received epidural labor analgesia, giving the epidural labor analgesic rate of 2.6%. The most common indication for epidural labor analgesia was maternal voluntary request which accounted for 24 (66.7%) of the population receiving analgesia. One (2.8%) parturient developed post-dural puncture headache which resolved spontaneously within 24 hours. Parturient who utilized labor epidurals were significantly older than 30 years of age (OR 3.16; 95% CI 1.51-6.62; p=0.002), Multi-parous (OR 26.65; 95% CI 3.64-100.00; p=0.001), and with higher income (OR 9.02; 95% CI 4.38-18.57; p=<0.001), but not with higher level of education (OR 0.56; 95% CI 0.27-1.16; p=0.114). Conclusion: The demand for labor epidural in the study center was low with a demand rate of 2.6% and post-dural puncture headache rate of 2.8%. The significant factors related to a parturient’s request for epidural analgesia during labor included age greater than 30 years, multiparity and higher income. There is a need for an enhanced awareness programs on obstetrics epidural analgesia.

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Intracranial Venous Thrombosis in the Parturient

Anesthesiology ◽

10.1097/01.anes.0000282103.70955.c4 ◽

2007 ◽

Vol 107 (4) ◽

pp. 652-658 ◽

Cited By ~ 23

Author(s):

Ellen M. Lockhart ◽

Curtis L. Baysinger ◽

David C. Warltier

Keyword(s):

Venous Thrombosis ◽

Regional Anesthesia ◽

Dural Puncture ◽

Clinical Presentation ◽

Case Reports ◽

Women Of Childbearing Age ◽

Postdural Puncture Headache ◽

Childbearing Age ◽

Post Dural Puncture Headache ◽

Presenting Symptoms

Intracranial venous thrombosis is a rare but potentially fatal complication of pregnancy and the postpartum period. The presenting symptoms can mimic those of a postdural puncture headache and are easily misdiagnosed, especially in a parturient who has undergone regional anesthesia. The incidence of 10-20 per 100,000 is likely higher than reported. The etiology, clinical presentation and course, risk factors, management, and relation of intracranial venous thrombosis to pregnancy are presented. Published case reports and series of intracranial venous thrombosis that have either occurred during the puerperium or involved women of childbearing age after dural puncture are summarized. Finally, the diagnosis and management of intracranial venous thrombosis in parturients, focusing on parturients who have undergone regional anesthesia, is discussed. When intracranial venous thrombosis occurs in a parturient after regional anesthesia, it is often treated as a post-dural puncture headache.

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