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Abstract
Objectives: After reading this article, readers should be able to recognize Post Dural Puncture Headache, understand its mechanism and diagnostic criteria, evaluate the different treatment options available, and be familiar with a novel treatment option. Background: Post-dural puncture headache is the most common serious complication resulting from lumbar puncture and epidural or spinal anesthetics. The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia. The syndrome incidence was reported to be approximately 1% with typical obstetric anesthesiology practice which reflects more than 20,000 cases per 2014 in the US. Two possible mechanisms are hypothesized as responsible for this syndrome; cerebrospinal fluid leakage and pneumocephalus. Multiple methods of treatment have been applied with wide-ranging results. Design or Methods: Review article with introduction of a novel treatment option. Results: We postulate that Hyperbaric Oxygen Therapy can be used to treat post-dural puncture headache. The rationale for treatment is dual: enhancement of fibroblast proliferation at the site of dural puncture to facilitate faster closure of the tear and compression of air bubbles in case of pneumocephalus according to Boyle’s law. We also claim that hyperbaric oxygen therapy should be considered a prophylactic treatment, if a dural tear is suspected.
Highlights
Spinal anesthesia has developed at the end of the 19th century
The syndrome is characterized by severe headache that occurs within 48 hours following the puncture, located in the frontal and/or occipital region, worsened in the upright position and refractory to routine analgesia
Obstetrical patients tend to have a greater incidence of post-dural puncture headaches, which is most likely caused by the larger size of the needle used for epidural anesthesia
Summary
Spinal anesthesia has developed at the end of the 19th century. Four years later (1895), Corning suggested local spinal anesthesia with cocaine to treat a man with habitual masturbation [2]. In 1898 Bier suffered and was the first to report Post Dural Puncture Headache (PDPH) after injecting cocaine into the subarachnoid space of seven patients including him and his assistant Hildebrandt. PDPH is reported to be the most frequent complication of spinal and epidural blocks. In the following article we attempted to gather all the information about the treatment options currently available. The purpose of the article is to introduce a new treatment option for PDPH, Hyperbaric Oxygen Therapy (HBOT). We believe that once an accidental dural puncture is suspected, HBOT should be started immediately to minimize the risk of development of PDPH. The rationale for treatment is fibroblast proliferation at the site of the puncture, the same mechanism that is applied for chronic wounds
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