Continuous epidural pumping of saline contributes to prevent and treat postdural puncture headache

Abstract

Study ObjectivePostdural puncture headache (PDPH) is the most common symptom of accidental dural puncture, a frequent complication of intraspinal anesthesia. We developed a postoperative intervention technique to prevent and treat PDPH in accidental dural puncture patients, including epidural pumping of saline. This retrospective study aimed to retrospectively evaluate this new technique for PDPH prevention and treatment. DesignRetrospective study. SettingBeijing Obstetrics and Gynecology Hospital affiliated to the Capital Medical University, between January 2006 and December 2012. PatientsEighty-seven cases undergoing intraspinal anesthesia were assessed. InterventionsOf these patients, 68 cases had successful repuncture and were assigned to group A (epidural filling group, n=68), receiving continuous epidural pumping of 0.9% NS (150mL) at a rate of 6mL/h; the remaining cases were assigned to group B (conservative therapy group, n=19). MeasurementsAge, height, and body weight were collected, and postoperative headache was assessed using a visual analog scale. Main ResultsOf 68 patients in group A, 49 (72.1%) developed PDPH, whereas all in group B developed PDPH (P=.009). In addition, all patients showed PDPH within 3days after surgery regardless of treatment group. However, a statistically significant difference was obtained for PDPH duration between groups A and B (P<.001). Multivariate logistic regression analysis showed that frequency of epidural puncture and continuous epidural pumping of saline were significant risk factors for PDPH. ConclusionsOur data indicated that application of 6mL/h saline effectively contributes to PDPH management, and its clinical application should be broadened.