Dural Puncture Headache Research Articles

Efficacy and Ease of Use of a Newly Designed Pencil-Point Epidural Needle Compared to Conventional Tuohy Epidural Needle: A Randomized Single-Blind Pilot Study.

Background and objectiveAccidental dural puncture (ADP) and consequent post-dural puncture headache (PDPH) related to epidural needle use have prompted the design of a pencil-point epidural needle. The aim of this prospective, randomized, single-blind pilot study was to assess the efficacy, ease of use, patient satisfaction, and adverse events associated with this newly designed pencil-point epidural needle compared to a Tuohy conventional epidural needle in parturients receiving combined spinal-epidural (CSE) anesthesia for labor.MethodsAfter obtaining the Institutional Research Board approval, 100 parturients were randomized to receive CSE anesthesia with either the new pencil-point epidural needle (Gertie Marx, IMD Inc., Huntsville, UT) (P group) or Tuohy needle (T group). We documented patients’ height, weight, loss of resistance (LOR), number of attempts required, onset time of spinal anesthesia, difficulties with insertion of spinal needle, difficulties with insertion of the epidural needle and catheter, duration of the procedure, overall satisfaction of the provider and patient, ADP, PDPH, paresthesia, and pain.ResultsThere was no difference in body mass index (BMI), LOR, number of attempts, and onset time of spinal anesthetic between the study groups. Success in obtaining cerebrospinal fluid (CSF) on the first attempt was 50/51 (98%) in the T group vs. 44/49 (89.8%) in the P group (p=0.108). The need for subsequent epidural needle readjustment to obtain CSF was higher in the P group (16/49, 32.7%) vs. the T group (3/51, 5.9%, p<0.001). Success on the first attempt with epidural catheter threading was lower with the pencil-point epidural needle compared to the Tuohy needle (69% vs. 98%, p<0.001). The anesthesiologist switched from the assigned pencil-point epidural needle to the Tuohy needle due to technical difficulties in 8/49 (16.3%) cases. The duration of the procedure was longer in the P group (16.43 ±6.33 minutes) compared to the T group (11.49 ±1.87 minutes) (p<0.001). User satisfaction was lower in the P group compared to the T group (34.7% vs. 90.2%, p<0.001). Patient satisfaction was lower with the pencil-point epidural needle compared to the Tuohy needle (75.5% vs. 92.2%, p=0.03). There was no difference in complication rates from the CSE procedure between groups (pain, paresthesia, ADP, and PDPH).ConclusionIn this pilot study, the use of the pencil-point epidural needle for CSE was associated with less successful epidural catheter placement as well as low user and patient satisfaction compared to the Tuohy epidural needle. Modifications in the pencil-point epidural needle design are needed to improve efficacy and enhance user acceptance before a larger study can be conducted to evaluate the rates of ADP and PDPH.

Study the Effect of Intravenous Infusion of Dexamethasone versus Magnesium Sulphate on Incidence and severity of Post Dural Puncture Headache in Parturient Undergoing Caesarean Section

Study the Effect of Intravenous Infusion of Dexamethasone versus Magnesium Sulphate on Incidence and severity of Post Dural Puncture Headache in Parturient Undergoing Caesarean Section

A randomized control study to assess the efficacy of the sphenopalatine ganglion block in patients with post dural puncture headache.

Post dural puncture headache (PDPH) delays discharge from hospital. We studied the efficacy of sphenopalatine ganglion (SPG) block, a novel technique in management of PDPH using 0.25% Ropivacaine. Forty patients presenting with PDPH after urological procedures under spinal anaesthesia were randomized into two groups: Group C and Group S. Group C received conservative treatment with bed rest, adequate hydration and caffeine 200 mg 6th hourly. Group S patients received SPG block (packing bilateral nostril for 10 minutes with 0.25% Ropivacaine). Inj Paracetamol 1 g IV was given as primary analgesic. Intravenous Diclofenac 75 mg was administered as rescue analgesic. Patients were monitored for 72 hours. Total analgesic requirement, time to attain adequate pain relief, headache pain score, patient satisfactory score were compared between the two groups. We compared the PDPH severity score for headache using 5-point scale method and patient satisfaction score using Likert-type scale. Demographic data, onset of PDPH, needle size, intervention time were statistically insignificant. Total paracetamol consumption was significantly reduced in SPG group. Headache pain score was significantly low in Group S up to 54 hours. Patient satisfaction score was statistically better in Group S. Mean block onset time was 12 minutes. One patient in Group C required Epidural blood patch. SPG block is an effective alternative in managing patients with PDPH. The need for epidural blood patch is greatly reduced using SPG block. Procedural safety, immediate and sustained pain relief make it an evolving treatment modality for PDPH.

Inadvertent Spinal Subdural (SSH) and Subarachnoid hematoma (SAH) from Epidural Blood Patch (EBP)

Inadvertent injection of autologous blood in both subdural and intrathecal spaces following EBP is extremely rare. Case reports describe SSH or SAH after attempted EBPs. This illustration depicts combined subdural and subarachnoid collection after EBP for post dural puncture headache (PDPH)(from a lumbar spinal drain), 6 days after 40 ml of autologous blood was injected in the “epidural space” at the same spinal level as the preceding spinal drain. The T1-weighted sagittal (Panel A) and axial (Panel B) MR image of the spine demonstrates a subdural collection of blood (white arrows) extending from T12-L1 to sacral level and subarachnoid collection of blood (asterisks) extending from L3-4 to the termination of the thecal sac at S2. Mild backache and neck stiffness is not uncommon after EBPs. Worsening back pain with radicular symptoms suggests blood in the subdural or subarachnoid spaces which can result in meningitis, arachnoiditis, lower extremity weakness and radiculopathy.

Sphenopalatine Ganglion Block versus Conservative Management for Post Dural Puncture Headache in Cesarean Section

Introduction: Post-dural puncture headache is one of the frequently encountered and inevitable post-operative complications of the subarachnoid block. The primary treatment is always considered conservative management in such instances. However, an epidural blood patch remains an invasive gold standard treatment. Sphenopalatine ganglion block is propounded as minimally invasive with prompt and better outcomes. Objective: To assess the efficacy of Sphenopalatine ganglion block (SPGB) when compared to conservative management based on the onset of analgesia and its duration. Methods: This is a prospective study performed on 40 obstetrics patients who underwent Lower segment cesarean section in Lumbini Medical College and Teaching Hospital (LMCTH) who complained of Post dural puncture headache within 7 days. All the parturients are categorized into Group A, those who are treated with sphenopalatine ganglion block, and Group B, where post-dural puncture headache was treated with conservative management. Independent t-tests and Fischer’s test were used for statistical analysis. Results: The patients in group A showed positive outcomes where all of them were relieved of post-dural puncture headache within 10 mins after Sphenopalatine ganglion block (p&lt;0.001) and the mean pain score, based on a numerical pain rating scale was less or equal to 4 for the first 8 hours. Conclusions: Sphenopalatine ganglion block (SPGB) could be used as an effective first-line treatment modality in the management of post-dural puncture headache compared to conservative management.

Bilateral sphenopalatine ganglion block with adrenaline additive for post-dural puncture headache in orthopedic patients: A randomized controlled trial

ABSTRACT Background Post dural puncture headache (PDPH) is a common condition that occurs following an accidental dural puncture. The work aimed to determine the efficacy and safety of analgesia of sphenopalatine ganglion block (SPB) (lidocaine 4% with adrenaline) for PDPH in orthopedic patients. Methods This randomized prospective open-label-controlled trial was conducted on 60 cases aged 18–60 years, both sexes American Society of Anesthesiologists (ASA) physical status I and II with severe PDPH during seven days after subarachnoid blockage for surgeries of lower limbs. Cases were randomized into two equal groups: Group MT: received medical treatment paracetamol 1 gm/6 hour daily, Group SPB: received SPB by using lidocaine 4% and adrenaline (1/2,000,000). The analgesia was effective if visual analogue scale (VAS) was < 4 in the first 48 hours. Patients with VAS ≥ 4 received diclofenac 75 mg/12 hour if pain was not controlled. Epidural blood patch was used in case of unrelieved pain after 3 days. Results There were significant quicker onset and longer duration of analgesia in group SPB compared to group MT (P = 0.001 and 0.03, respectively). VAS score was insignificantly different at baseline and 48 hours and was significantly lower in group SPB compared to group MT at 30 min, 1 h, 2 h, 6 h, 12 h, and 24 h. The need for EBP was significantly lower in group SPB B than group MT (16.7% versus 46.7%). Conclusions SPB is an effective method for PDPH in orthopedic patients with quicker onset and longer duration of analgesia and lower VAS score compared to medical treatment.

Epidural blood patch in the treatment of severe post dural puncture headache after spinal anesthesia: A rare case report.

Introduction and importanceSpinal anesthesia is a type of regional anesthesia that involves injecting a local anesthetic directly into the cerebrospinal fluid. In Ethiopia, the prevalence of PDPH was 42.6%, with large spinal needles and repeated attempts being independently associated risk factors.Case presentationA 20-year-old woman is undergoing a cesarean section while under spinal anesthesia. On the second postoperative day, the patient begins to complain of PDPH-like headaches. The headache was severe according to the VAS score, and the team attempted to manage it using the WHO analgesic ladder, but it was refractory to supportive and pharmaceutical therapy. We then used EPDBP, and the headache was promptly reduced. The treatment had a considerable impact on the movement, satisfaction, and discharge conditions of the patients.Clinical discussionA prospective research conducted in Helsinki found that EBP was effective in 88–96% of the patients in the various study groups.One randomized, double-blind trial on the therapeutic efficacy of EPDBP found that it is an effective treatment for PDPH. It provides complete symptom relief in a high number of people. In the remaining patients, it lessens the severity of their headaches and allows them to resume their normal activities.An epidural blood patch is a highly successful treatment option for a subset of people suffering from post-Dural puncture headache. It is an elective procedure with a low risk of complications.ConclusionThe epidural blood patch procedure that we use proved helpful in treating severe PDPH after spinal anesthesia for cesarean delivery. There were no complications associated with the procedure until she was discharged from the hospital.

The Relationship Between Nutritional Status with Post Dural Puncture Headache Incident in Sectio Caesarea Patients with Spinal Anesthesi

Background: Post dural puncture headache (PDPH) is one of the most common complications of spinal anesthesia caused by leakage of cerebrospinal fluid (CSS) after anesthesia procedures. One of the factors that influence the incidence of PDPH is nutrional status where obese patients tend not to experience PDPH. This is based on an increase intraabdominal pressure in obese patients which can reduce CSF leakage in the epidural space. Purpose: Purpose of this study to determine whether there was a relationship between nutritional status and post dural puncture headache incident in sectio caesarea patients with spinal anesthesia at Aliyah 2 Hospital. Methods: This study used an observational analytic study with a cross sectional approach carried out at Aliyah 2 Hospital. The number of samples in this study was 51 people who were taken using total sampling technique. Data collection was obtained from medical records and filling out observation sheets for post-sectio caesarea patients with spinal anesthesia and then analyzed using the Fisher’s Exact Test. The dependent variable in this study was PDPH and the independent variables was the nutrional status. Result: This study showed that nutritional status (p = 0.007) had a significant relationship with the incidence of PDPH at Aliyah Hospital 2. Conclusion: From this study it could be concluded that the incidence of PDPH after spinal anasthesia is higher in patients with low BMI.

Incidence and associated factors of post dural puncture headache in cesarean section done under spinal anesthesia 2021 institutional based prospective single-armed cohort study

BackgroundSpinal anesthesia is the most commonly used anesthesia technique for Cesarean delivery with 80%–95% prevalence. The most common complication of SA is post-dural puncture Headache which is associated with dural puncture & Cerebrospinal fluid leak. This study aimed to assess the incidence and associated factors of post-dural puncture headache. Methodssingle-armed cohort study design was employed on 412 women from May 2021 to January 2022. Study subjects were selected using systematic random sampling. Descriptive statistics for each variable, binary logistic regression, and multiple logistic regression analysis with 95% CI was carried out. ResultsThe overall incidence of post-dural puncture headache in this study was 25.7%. 43.9% of Post dural headache was detected in the 1st 24 h followed by 48 h. Of those who develop Post-dural headaches, 54.1% of them had mild pain, 17.3% of them was moderate pain and 28.6% of them suffered severe pain. The multivariable analysis indicated that BMI>30 kg/m2 [AOR 2.85 95% CI: 1.91–4.25], number of attempts (>3), (AOR = 1.5, 95% CI: 1.19–1.91), and cephalic needle direction (AOR = 5.79 95% CI: 2.27–12.22), were factors associated with increased post-dural puncture headache. While large gauge needle size (AOR = 0.28 95% CI: 0.19–0.42), and greater than 3 years of experience of anesthetist (AOR = 0.44, 95% CI: 0.31–0.62) were associated with decreased incidence of post-dural puncture headache. ConclusionThe incidence of post-dural puncture headache was higher in BMI>30 kg/m2, greater than 3-time attempts during spinal anesthesia, using low gauge spinal needles, less than 3 years of experience as anesthetist and cephalic needle direction.

P.183 Parafalcine subdural haemorrhage after accidental dural puncture; a reminder to consider alternative differentials for post dural puncture headaches

P.183 Parafalcine subdural haemorrhage after accidental dural puncture; a reminder to consider alternative differentials for post dural puncture headaches

Post-dural puncture headache diagnosis and management.

Epidural analgesia, commonly used to alleviate labor pain, is not without complication. The most common complication associated with labor epidural analgesia (LEA) is Unintentional Dural Puncture (UDP), where many professionals go on to develop a Post Dural Puncture Headache (PDPH). Spinal anesthesia can also result in PDPH. Other complications of dural puncture necessitating further treatment include hospital readmission, persistent headache, persistent backache, cerebral venous thrombosis, subdural hematoma, postpartum depression, post-traumatic stress disorder, and decreased maternal breastfeeding. In this article, we will define and discuss the definition and diagnosis for PDPH, the pathophysiology of PDPH, PDPH treatment options including conservative therapy, pharmacologic therapy, and invasive procedural measures including the therapeutic epidural blood patch, prophylactic epidural blood patch, intrathecal catheter placement after UDP, and potential new therapies.

Recognized and unrecognized dural punctures in 12,981 labor epidurals: an audit of management

PurposeUnintentional dural puncture (DP) and post-dural puncture headache (PDPH) continue to cause discomfort and disability in a small proportion of post-partum women. We report an audit of the management of recognized and unrecognized DP over 10 years.MethodsClinical data were prospectively collected for women who experienced a recognized DP or developed symptoms following a neuraxial procedure. Details were documented regarding patient characteristics, the neuraxial procedure, symptoms reported, and epidural blood patches. We reported rates of recognized DP, unrecognized DP, PDPH, and blood patches performed. Data were presented as number (percent) and proportions of interest compared using Chi square analysis.ResultsBetween January 2009 and December 2018, 12,981 women utilized labor epidural analgesia. A recognized DP occurred in 131 (1.0%) and an unrecognized DP in 60 (0.5%), with unrecognized DPs comprising 31% of the total. Of 131 recognized punctures, 86 (66%) developed a PDPH. A total of 146 (1.1%) women experienced a PDPH. Of those, a blood patch was performed in 93 (64%). Intrathecal catheters were inserted for > 24 h in 43 (33%) women with a recognized DP. Of those, 33 (77%) developed a PDPH, compared to 53 (60%) of those without an intrathecal catheter in situ for > 24 h (P = 0.06).ConclusionsRates of DP were consistent with those reported by others. Unrecognized DP comprised a third of all DP, and systematic post-neuraxial follow-up is essential to identify these women. Epidural blood patch was performed in most women experiencing symptoms of PDPH.

Dexamethasone in Preventing Post Dural Puncture Headache

Background and Aim: Post-dural puncture headache is major complication of spinal anesthesia that occurs in 40% of cases. Invasive treatment like an epidural blood patch might be required for post-dural puncture headache. The Dexamethasone effect on Post-Dural Puncture Headache following spinal anesthesia is not addressed and well understood. The aim of the present study was to assess the role of Dexamethasone in post-dural puncture headaches. Materials and Methods: This cross-sectional study was carried out on 456 patients who underwent spinal anesthesia from 16th April 2021 to 15th October 2021 at the department of Anesthesiology of Pakistan Ordnance Factories (POF)Hospital,WahCantt, Mayo Hospital, Lahore andMohi-ud-Din Teaching Hospital, Mirpur AJK. All the patients who underwent spinal anesthesia were enrolled whereas patients with previous headache disorder and contraindicated for steroids were excluded. Patients were allocated to two groups; Group A (Placebo) and Group B (Dexamethasone). Placebo group patients were injected with normal saline (2 mL) and other group patients with dexamethasone prophylactic epidural injection (2 mL, 8 mg). The incidence and severity of post-dural puncture headache and backache at the puncture site were evaluated on the 1st, 3rd, and 7th postoperative days. SPSS version 24 was used for data descriptive analysis. Results: A total of 456 patients underwent spinal anesthesia in which 228 patients over age of 20 years were assigned to each group. The prevalence of post-dural puncture headache was found lower in dexamethasone group patients 14 (6.2%) compared to normal saline 26 (11.6%) on the post-operative first day (p&lt;0.05). However, on days 3 and 7, the difference disappeared. The overall prevalence of post-dural puncture headache was 21 (9.4%) in the dexamethasone group and 11 (4.7%) in the placebo group, which is statistically insignificant (p-value=0.132). There was no statistical significance in terms of headache severity (2.7% in the study group versus 7% controls group; p-value =0.128). The incidence of symptoms like vomiting or nausea occurred in a lower number of dexamethasone group patients compared to placebo. The prevalence of backache between the two groups was found insignificant. Conclusion: Our study found that the prevalence of post-dural puncture headache was lower in dexamethasone group patients but improved with increasing post-operative days and extended to the placebo group. Our findings contradict the earlier studies in regard to dexamethasone's effectiveness in post-dural puncture headache treatment. Based on our findings, dexamethasone cannot be recommended for post-dural puncture headaches. Keywords: Post-Dural puncture headache; Dexamethasone; Spinal Anesthesia

Prone position: A possible method to decrease post dural puncture headache (PDPH) during surgery

ObjectivesPostdural puncture headache (PDPH) is a complication associated with spinal and epidural anesthesia, characterized by a very severe dull, non-throbbing positional headache along with nausea, vomiting and other symptoms. The aim of this study was to compare positional character of PDPH, where the effects of prone and supine positions during surgery were compared for the risk of the headache. MethodsThis cohort study, was carried out at (XXX) University of Medical Sciences from June 2019 to June 2020 after the approval from the Ethical Committee. 1416 patients participated in this study among whom either supine or prone positions were used for the surgery, based on the type of surgical requirements. All patients received spinal where, 18-gauge cannula was inserted and lactated ringer 4 mL per Kg per hour was used for the administration. Using an aseptic technique, a 26-gauge Quincke needle was inserted intrathecally via a midline approach into the L3-L4 or L4-L5 interspace with the patient in the sitting position. Patients received 10 mg 0.5% hyperbaric bupivacaine. 444 patients were operated in the prone position during surgery (P group) and the 972 patients were in the supine position (S group). ResultsWe compared the rate of PDPH between the two groups. 3 (0.68%) patients with pilonidal sinus were operated in prone position experienced headache and 87 of those operated in supine position (8.95%) had headache (P < 0.001); and the odds ratio of developing headache when operated in supine position was 13.16. ConclusionsProne position during surgery appears to be a reliable way to reduce PDPH following spinal or epidural anesthesia.

Epidural Blood Patch for Post Dural Puncture Headache Management: Our First Experience

Epidural Blood Patch for Post Dural Puncture Headache Management: Our First Experience

Bilateral Sphenopalatine Ganglion Block for the Treatment of Post Dural Puncture Headache: A Case Report

Background: Post dural puncture headache (PDPH) is a known and potentially debilitating complication of neuraxial anesthesia that can impede patient recovery. The conventional treatment includes hydration and symptomatic treatment like simple analgesics. Those who have unremitting symptoms following conservative measures are offered an epidural blood patch (EBP). However, EBP, an invasive procedure, is associated with complications in itself. Case: We report a 40-year-old man who experienced PDPH after spinal anesthesia. His symptoms recurred after conservative management was instituted. He was then offered a trans-nasal sphenopalatine ganglion (SPG) block. He had excellent pain relief and did not require an EBP. Conclusion: SPG blocks can be considered early in the treatment of PDPH together with general supportive measures. However, if pain relief is not achieved, an epidural blood patch should still be considered.

Incidence and Risk Factors of "Postdural Puncture Headache" in Women Undergoing Cesarean Delivery under Spinal Anesthesia with 26G Quincke Spinal Needle, Experience of Medical College in Rural Settings in India 2019: A Prospective Cohort Study Design.

Introduction:Almost every cesarean delivery is done under spinal anesthesia because of ease of doing, rapid onset, avoids maternal and fetal risk of general anesthesia, promotes early recovery. Major complication especially in young women undergoing LSCS under spinal anesthesia is post dural puncture headache (PDPH) which is caused by cerebrospinal fluid leakage. There is wide variation in reported incidence of PDPH (0.3% to 40 %) after spinal anesthesia being affected by various procedure and non procedure related risk factors like age, gender, needle size and type, numbers of spinal attempts and previous history of PDPH.Methods:Prospective cohort study was conducted in 335 patients posted for caesarean section under spinal anesthesia from January 2019 to September 2019 in medical College situated in rural India. Spinal anesthesia was given by 26 G Quincke spinal needle. All patients were evaluated for incidence and severity of PDPH from post operative day 1 to day 5.Result:Incidence of PDPH was 11.4% in this study. Majority of patients (62.5%) were having mild pain. All patients reported PDPH with 72 hours.Conclusion:Body mass index (BMI), h/o PDPH, multiple attempts for successful spinal anesthesia did not have any significant association with PDPH in our study.

Sphenopalatine Ganglion Block for Treatment of Post Dural Puncture Headache: Review‏ Article

Sphenopalatine Ganglion Block for Treatment of Post Dural Puncture Headache: Review‏ Article

A Comparison of the Effects of Spinal Anaesthesia between Sitting and Lateral Positions in Patients Undergoing Hysterectomy Surgery

Aim: The main purpose of this present study is to determine the effects of sitting (S) and lateral (L) position during spinal anaesthesia on patient satisfaction, Post dural puncture headache (PDPH), Post-Operative Nausea and Vomiting (PONV).&#x0D; Study Design: Prospective comparative study&#x0D; Place and Duration of Study: Charusat Healthcare and Research foundation (CHRF), Changa, Gujarat, between September 2021 to November 2021.&#x0D; Methodology: A total of 50 female volunteers who were above the age of 18 years, had an American Society of Anaesthesiologist (ASA) status of I &amp; II and those who have undergone hysterectomy surgery are included in this study. The patients were categorized into two groups, group S (n=25) and group L (n=25). Patients were asked about PONV 4 hours after surgery and the possibility of PDPH on post-operative days 1 and 2. The study was analysed by using descriptive statistics, chi-square and Kruskal-Wallis test.&#x0D; Results: When comparing the incidence of PDPH on post-operative day 1 and day 2, there is a statistically significant difference between the Sitting (group S) and Lateral decubitus (group L) groups (P-value= 0.14 and.001). On the other hand, there is no statistical significant difference found for PONV when compared between both the groups (P- value= .776).&#x0D; Conclusion: Spinal anaesthesia with lateral decubitus position has better outcomes than sitting position for the incidence of Post dural puncture headache. However, there is no difference in both groups for PONV.

Frequency of Post Dural Puncture Headache with Quincke 25g and Quincke 27g Spinal Needle after Spinal Anaesthesia

Objective: To compare the frequency of post dural puncture headache with Quincke 25G and Quincke 27G of spinal needles for spinal anesthesia. Design of the Study: It’s a Randomized control trial. Study Settings: This study was carried out Department of anesthesiology and Intensive Care Unit, Shaikh Zayed Hospital Lahore from 29-08-2020 to 01-03-2021. Material and Methods: In this prospective study 100 patients were enrolled who were decided to undergo spinal anesthesia. Two groups were made by randomization. In patients of group I, anesthesia was administered by using 25G quincke needle while 27G quincke needle was used for patients in group II. Evaluation of patients was with regard to development of postoperative PDPH within 3-days. Groups were compared by using Chi-square test and a P-value&lt;0.05 was taken statistically significant. Results of the Study: PDHD was seen in 14 (28%) patients in group I and in 4 (8%) patients in group II. Statistically, the difference between the two groups was significant (p&lt;0.05).. Conclusion: Due to less frequency of PDPH with 27G needle, it should be given preference for applying spinal anesthesia over 25G needle. Keywords: Spinal anesthesia, post dural puncture headache; quincle needle.