Parche hemático epidural en el tratamiento de cefalea postpunción dural grave en cirugía mayor ambulatoria

Abstract

We report a case of postdural puncture headache (PDPH) after outpatient hysteroscopy under spinal anesthesia in which a 25-gauge Whitacre needle was used. Symptoms of PDPH appeared 6 hours after surgery. The headache improved with oral caffein and intravenous corticosteroids and the patient was discharged after 24 hours. Later, she was attended twice in the emergency departments of 2 hospitals, where she received conventional treatment (analgesics and corticosteroids). Eleven days after the surgical procedure, an epidural blood patch was performed. Within 12 hours the incapacitating symptoms had improved markedly and resolution was complete 2 months after surgery. PDPH worthy of blood patch treatment is a rare complication of spinal anesthesia with pencil-point needles. Clear diagnostic protocols are required if satisfactory treatment is not to be delayed and unnecessary suffering is to be prevented.