Perioperative management of postdural puncture headache: Postdural puncture headache
Introduction: Postdural puncture headache (PDPH) is a complication of puncture of the dura mater. It is a common side effect of spinal anesthesia, lumbar puncture and occasionally, may accidentally occur in epidural anesthesia. The headache is defined as a bilateral headache that develops within 7 d...
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| Format: | Article |
| Language: | English |
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Serbian Society of Anesthesiologists and Intensivists
2016-01-01
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| Series: | Serbian Journal of Anesthesia and Intensive Therapy |
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| Online Access: | http://scindeks-clanci.ceon.rs/data/pdf/2217-7744/2016/2217-77441604101U.pdf |
| _version_ | 1817994746245677056 |
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| author | Unić-Stojanović Dragana Zečević Marija |
| author_facet | Unić-Stojanović Dragana Zečević Marija |
| author_sort | Unić-Stojanović Dragana |
| collection | DOAJ |
| description | Introduction: Postdural puncture headache (PDPH) is a complication of puncture of the dura mater. It is a common side effect of spinal anesthesia, lumbar puncture and occasionally, may accidentally occur in epidural anesthesia. The headache is defined as a bilateral headache that develops within 7 days after lumbar puncture and disappears within 14 days. It has been described in some cases that headaches can last from a few mounts to even years. Factors that increase the risk of PDPH is young age, female sex and pregnancy. Incidence is strongly related to the needle size and type. Case Report: We report a case of a 49-year-old man who was admitted to our Institute for elective veins surgery. We choose spinal anesthesia for this operation and use 25 gauged spinal needle. Patient was hemodynamically stable during the whole surgery without headache and he was discharged home at 1st post operative day. However, after two days, patient came to the hospital complaining of severe headache in frontal and occipital areas, followed by neck stiffness. Our first approach in treatment was conservative therapy. Recumbent positioning, oral and intravenous fluid, 500 mg coffeine iv. bid and morphine 4 qid. The headache persisted for the next 2 days, despite conservative therapy. Our next approach was epidural blood patch like effective treatment for PDPH. First we placed patient in the lateral position and inserted epidural needle at the level L3 - L4. Then we injected 15 ml of autologes blood into epidural space. His headache resolved within one hour of procedure, he denied any further headache one month after discharge. Conclusion: In our case, it was shown that lumbar puncture is an important cause of iatrogenic morbidity in the form of postdural puncture headache. Incidence of headache can be resolved by using thinner needle. When the headache does not respond to conservative therapy, epidural blood patch is a reasonable and effective treatment. Surgical closure is the last option. |
| first_indexed | 2024-04-14T01:56:20Z |
| format | Article |
| id | doaj.art-72dd12a0f04946718c3160c2ce4d8a2e |
| institution | Directory Open Access Journal |
| issn | 2466-488X |
| language | English |
| last_indexed | 2024-04-14T01:56:20Z |
| publishDate | 2016-01-01 |
| publisher | Serbian Society of Anesthesiologists and Intensivists |
| record_format | Article |
| series | Serbian Journal of Anesthesia and Intensive Therapy |
| spelling | doaj.art-72dd12a0f04946718c3160c2ce4d8a2e2022-12-22T02:19:04ZengSerbian Society of Anesthesiologists and IntensivistsSerbian Journal of Anesthesia and Intensive Therapy2466-488X2016-01-01383-410110410.5937/sjait1604101U2217-77441604101UPerioperative management of postdural puncture headache: Postdural puncture headacheUnić-Stojanović Dragana0Zečević Marija1Institut za kardiovaskularne bolesti 'Dedinje', Beograd + Medicinski fakultet, BeogradUniversity of Belgrade, Faculty of Medicine - Institute of Cardiovascular Diseases 'Dedinje', Belgrade, SerbiaIntroduction: Postdural puncture headache (PDPH) is a complication of puncture of the dura mater. It is a common side effect of spinal anesthesia, lumbar puncture and occasionally, may accidentally occur in epidural anesthesia. The headache is defined as a bilateral headache that develops within 7 days after lumbar puncture and disappears within 14 days. It has been described in some cases that headaches can last from a few mounts to even years. Factors that increase the risk of PDPH is young age, female sex and pregnancy. Incidence is strongly related to the needle size and type. Case Report: We report a case of a 49-year-old man who was admitted to our Institute for elective veins surgery. We choose spinal anesthesia for this operation and use 25 gauged spinal needle. Patient was hemodynamically stable during the whole surgery without headache and he was discharged home at 1st post operative day. However, after two days, patient came to the hospital complaining of severe headache in frontal and occipital areas, followed by neck stiffness. Our first approach in treatment was conservative therapy. Recumbent positioning, oral and intravenous fluid, 500 mg coffeine iv. bid and morphine 4 qid. The headache persisted for the next 2 days, despite conservative therapy. Our next approach was epidural blood patch like effective treatment for PDPH. First we placed patient in the lateral position and inserted epidural needle at the level L3 - L4. Then we injected 15 ml of autologes blood into epidural space. His headache resolved within one hour of procedure, he denied any further headache one month after discharge. Conclusion: In our case, it was shown that lumbar puncture is an important cause of iatrogenic morbidity in the form of postdural puncture headache. Incidence of headache can be resolved by using thinner needle. When the headache does not respond to conservative therapy, epidural blood patch is a reasonable and effective treatment. Surgical closure is the last option.http://scindeks-clanci.ceon.rs/data/pdf/2217-7744/2016/2217-77441604101U.pdfspinal anesthesiapostdural puncture headacheepidural blood patch |
| spellingShingle | Unić-Stojanović Dragana Zečević Marija Perioperative management of postdural puncture headache: Postdural puncture headache Serbian Journal of Anesthesia and Intensive Therapy spinal anesthesia postdural puncture headache epidural blood patch |
| title | Perioperative management of postdural puncture headache: Postdural puncture headache |
| title_full | Perioperative management of postdural puncture headache: Postdural puncture headache |
| title_fullStr | Perioperative management of postdural puncture headache: Postdural puncture headache |
| title_full_unstemmed | Perioperative management of postdural puncture headache: Postdural puncture headache |
| title_short | Perioperative management of postdural puncture headache: Postdural puncture headache |
| title_sort | perioperative management of postdural puncture headache postdural puncture headache |
| topic | spinal anesthesia postdural puncture headache epidural blood patch |
| url | http://scindeks-clanci.ceon.rs/data/pdf/2217-7744/2016/2217-77441604101U.pdf |
| work_keys_str_mv | AT unicstojanovicdragana perioperativemanagementofpostduralpunctureheadachepostduralpunctureheadache AT zecevicmarija perioperativemanagementofpostduralpunctureheadachepostduralpunctureheadache |