Duration Of Postdural Puncture Headache Research Articles

Oral Ergotamine versus Theophylline as Treatment of Post-dural Puncture Headache (PDPH) in Cesarean Section: A Randomized Clinical Trial

Introduction: Post Dural Puncture Headache is (PDPH) a relatively common complication of spinal anesthesia. This study aimed to compare the effect of oral administration of ergotamine and theophylline on PDPH in patients undergoing a cesarean section. Materials and Methods: This clinical trial was performed on 60 parturients undergoing cesarean section with PDPH. A tablet of theophylline (100 mg) or methyl ergotamine C (1 mg plus 100 mg caffeine) every 8 hours for 24 hours was administered randomly to patients referred to the hospital with PDPH. Using a checklist, demographic information, history of previous PDPH, number of punctures and intensity, location, and onset time of headache were collected. Intensity and duration of PDPH in the first 24 hours after surgery were the primary outcomes and nausea, vomiting, and vertigo were considered secondary outcomes. The intensity of the headache was assessed using Visual Analog Scale (VAS) before and within the first 24 hours after drug administration. Results and Discussion: In both groups, the VAS of headache significantly decreased at 2, 8, and 24 hours after administration of theophylline and ergotamine compared to pre-intervention time (theophylline from 8.6 ± 1.1 to 0.2 ± 0.1 and ergotamine from 8.6 ± 1.5 to 0.4 ± 0.2). However, the intensity of headaches was not different between the two groups at 2, 8, and 24 hours after the intervention. Duration of headache was similar in both groups (15.7 ± 5.9 in the theophylline group versus 17.5 ± 14.2 ergotamine group). In terms of secondary outcomes of nausea, vomiting, and vertigo, both groups were comparable. Conclusion: Oral administration of theophylline and ergotamine are similarly effective in reducing PDPH in cesarean sections. Clinical Trial Registration Number: IRCT20120915010841N14.

A Comparison of Incidence of Post Dural Puncture Headache Using 25G Quincke and 25G Whitacre Needle in Obstetric Patients Undergoing Caesarean Section under Spinal Anesthesia

Introduction: Spinal anesthesia has offered a new armamentarium for the anesthesiologists and has been widely used in the Cesarean section in the field of obstetrics, an alternative to general anesthesia. However, Post Dural Puncture Headache remains an inevitable complication of spinal anesthesia and can be minimized its incidence by reducing the size of the needle and changing the design of the needle tip. The objective of the study was to find the incidence of post-dural puncture headache undergoing subarachnoid block for CS using 25G Quincke and 25G Whitacre needles.
 Materials and methods: This study was conducted from August 2020 to January 2021 enrolling 72 parturients and were allocated in two groups of 36 each. Group A and B parturients received spinal anesthesia via. 25G Quincke and 25G Whitacre in sitting position respectively. All the patients were evaluated based on incidence, onset, duration, and severity of headache postoperatively for 72 hours after the subarachnoid block.
 Results: The incidence of post-dural puncture headache in the study was 7.2% in Group A and 3.15% in Group B which was statistically significant (P-value = 0.011), while there were no significant differences between these two groups in the onset, severity, and duration of post-dural puncture headache.
 Conclusion: Despite no significant differences were found for the onset, severity, and duration of post-dural puncture headache, the use of 25G Whitacre is associated with a reduced incidence of post-dural puncture headache compare to 25G Quincke.

Is theophylline more effective than sumatriptan in the treatment of post-dural puncture headache? A randomized clinical trial

ABSTRACT Objectives: To compare the safety and efficacy of oral theophylline versus oral sumatriptan in the treatment of post-dural puncture headache (PDPH).Background: PDPH is the most frequent complication of procedures associated with a dural puncture for spinal anaesthesia, cerebrospinal fluid (CSF) sampling, or following inadvertent dural puncture during epidural anaesthesia. Since invasive treatments have known complications, pharmacologic management may be preferable.Patients and Methods: This was a prospective, randomized, double-blind, phase four, comparative clinical trial; carried out on 60 patients presented with PDPH at Damanhour Teaching Hospital, El Beheira, Egypt; between February 2020 and May 2021. Patients were randomly allocated into two equal groups; group T, which received oral theophylline, and group S, which received oral sumatriptan.Results: There were no statistically significant differences between both groups as regards: demographic data, American Society of Anesthesiologists (ASA) physical status, type of operation, type, and size of the spinal needle. PDPH duration and length of hospital stay were significantly shorter in group T than in group S. Numerical pain rating scale (NPRS) scores were significantly lower in group T than in group S. Palpitation, dizziness, gastric irritation, and nausea/vomiting occurred in both groups with no statistically significant differences. No patient in either group needed an epidural blood patch.Conclusion: Oral theophylline is more effective and safer than oral sumatriptan in the treatment of PDPH. It lowered NPRS scores, shortened the duration of PDPH, and length of hospital stay, and was associated with minimal side effects.

The Effect of Midazolam on Prevention of Post-Dural-Puncture Headache

Objective: Post-dural-puncture headache (PDPH) is the most common side effect associated with a lumbar puncture (LP). The present study aims to evaluate the effect of midazolam on the prevention of PDPH. Methods: This single-blind randomized clinical trial study was performed on 120 patients aged 18-60 years who were candidates for diagnostic LP in 2017-2018. In the intervention group (n=30), 3 mg of midazolam was injected intravenously for two minutes 5-10 minutes before LP, and the control group received normal saline as placebo. Patients in both groups were evaluated and compared with each other in terms of incidence, onset, severity, and duration of PDPH. Results: The incidence of PDPH was lower in the midazolam group, but the difference was not significant (P>0.05). Mean severity, onset time, and duration of PDPH were not significantly different between the two groups (P<0.05). All patients in the intervention group and 75% of patients in the control group with PDPH had a history of headache. There was no significant difference between gender, mean age, BMI, pressure and CSF volume in patients with PDPH (P>0.05). The mean age of patients with PDPH was significantly lower in both groups, and the percentage of women with PDPH was considerably higher than that of men (P<0.05). Conclusion: Although there was no significant difference between the parameters studied in the two groups, patients with less age, history of headache, lower CSF pressure, and female gender were more likely to develop PDPH.

Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial.

Background and Aims:Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH.Methods:This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25.Results:Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group.Conclusion:Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.

Role of prednisolone in management of post-dural puncture headache after spinal anesthesia in obstetric patients

Background and Aims: Post-dural puncture headache (PDPH) is a common cause of morbidity in patients subjected to dural puncture for spinal anesthesia. PDPH is mostly a benign condition but can lead to delayed hospital discharge and considerable morbidity for the parturient. We aimed to study whether there is a positive role of prednisolone in post dural puncture headache management (after spinal anesthesia) in patients undergoing lower segment cesarean section (LSCS). Methodology: A randomized controlled trial was conducted at department of gynecology and obstetrics, in Combined Military Hospital (CMH), Nowshera, from April 2018-September 2018. A sample size of 60 patients was determined through WHO calculator. Patients were selected through non probability consecutive sampling after ethical committee approval and consent forms were taken. Patients were randomly categorized into two groups. Group A was given tablet prednisolone while Group B was given a placebo tablet. Patients were followed for pain measurement using visual analogue scale (VAS). Data were analyzed using SPSS version 24. T-test and Chi-square test were applied. A p ≤ 0.05 was considered significant.Results: A total of 60 women undergone c sections were included in study. Mean age of women was 28.5 years ± 4.3. Mean pain scores were significantly reduced in prednisolone group as compared to placebo at 24, 48, 72 and 96 h (p = 0.00). Majority of patients in placebo group had severe headache as compare to oral prednisolone group after 96 h (p = 0.00).Conclusion: Post-Dural Puncture Headache is a major complications following LSCS in spinal anesthesia. Oral prednisolone usage is very effective in lowering severity of headache and duration of PDPH. Oral prednisolone also limits adverse events associated with PDPH after LSCS performed in spinal anesthesia.Citation: Afridi N, Fareed A, Fatima A, Role of prednisolone in management of postdural puncture headache after spinal anesthesia in obstetric patients . Anaesth. pain &amp; intensive care 2019;23(2):168-171

Role of Oral Prednisolone in the Management of Postdural Puncture Headache after Spinal Anesthesia in Urological Patients.

Background and Aims:Postdural puncture headache (PDPH) is a frequently encountered complication of spinal anesthesia and may be associated with significant morbidity in some patients. Parenteral corticosteroids have been used in the management of PDPH both prophylactically and after the occurrence of headache. The aim of this study was to evaluate the effect of oral prednisolone in the management of PDPH after spinal anesthesia in urological patients.Materials and Methods:Sixty adult patients who developed PDPH after spinal anesthesia for urological surgeries were randomly allocated to two groups. Group C patients (n = 30) were managed conservatively, and Group P patients (n = 30) were given 20 mg of oral prednisolone for 4 days in addition to the conventional treatment. The intensity of headache was measured using visual analog scale (VAS). VAS score was taken just before the start of treatment (0 h) and at 12, 24, 48, 72, and 96 h after the start of treatment.Statistical Analysis:Statistical analysis was performed using Statistical Packages for Social Science version 19 (SPSS, Inc., Chicago, IL, USA).Results:There was no statistically significant difference in the VAS score in patients before the start of treatment (0 h) and at 12 h after the start of treatment. The VAS scores were less and statistically significant in Group P at 24, 48, 72 and 96 h after the start of treatment (P < 0.05).Conclusion:The use of oral prednisolone is effective in reducing the severity and duration of PDPH.

Postdural puncture headache: impact of needle type, a randomized trial

Background contextThe most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. PurposeThe purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. Study designThe study is based on a prospective, randomized, and simple-blinded clinical trial. Patient SamplePatients older than 14 years were scheduled for a diagnostic or therapeutic LP. Outcome MeasuresThe outcome measure included the development of PDPH according to the International Headache Association criteria. MethodsPatients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. ResultsThe incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. ConclusionsWe found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.

Postdural puncture headache in migraineurs and nonheadache subjects

To prospectively assess 1) the incidence and duration of postdural puncture headache (PDPH) in migraineurs and healthy subjects; 2) the associated risk factors; and 3) the risk of getting a migraine attack shortly before or after lumbar puncture (LP). As part of an extensive biochemical migraine research program, we assessed the occurrence, duration, and characteristics of PDPH in 160 migraineurs and 53 age- and sex-matched healthy controls. In addition, we evaluated potential risk factors for PDPH as well as the risk of developing a migraine attack before or after LP. In total, 64 of 199 subjects (32.2%) developed PDPH. Young age, low body mass index, severe headache immediately after LP, and sitting sampling position, but not being a migraineur, increased the risk of PDPH (all p < 0.05). Duration of PDPH was prolonged by history of depression, sitting sampling position, high perceived stress during the LP procedure, and multiple LP efforts (all p < 0.05). Migraine attacks were less likely to occur before or shortly after LP. Migraineurs are not at increased risk of developing PDPH. PDPH duration is similar in migraineurs and age- and sex-matched controls. LP does not trigger migraine attacks, and the stress of an upcoming LP might even have a protective effect against onset of migraine attacks.

Cosyntropin for Prophylaxis against Postdural Puncture Headache after Accidental Dural Puncture

The aim of the current study was to investigate the effect of administration of cosyntropin after accidental dural puncture (ADP) on the incidence of postdural puncture headache (PDPH) and the need for therapeutic epidural blood patch (EBP). Ninety parturients who suffered an ADP were studied. After delivery, patients were randomly assigned to one of two equal-sized groups. In group I (cosyntropin group), patients received cosyntropin in a dose of 1 mg intravenously. In group II (control group), patients received an equal volume of normal saline. Fifteen patients (33%) in the cosyntropin group suffered from PDPH, compared with 31 patients (68.9%) in the control group (P = 0.001). Significantly fewer patients in the cosyntropin group required an EBP, compared with the control group (5 patients [11.1%] vs. 13 patients [28.9%], respectively; P = 0.035). The Kaplan-Meier curves for the occurrence of PDPH showed a hazard ratio of 0.32 (95% CI = 0.16-0.55, P < 0.0001). The time from ADP to occurrence of PDPH was significantly longer in the cosyntropin group (27.2 [7.7] h) in comparison with the control group (17.5 [4.9] h; P < 0.001). However, there were no statistically significant differences among patients who developed PDPH in both groups with regard to the severity or duration of PDPH or with regard to the need for EBP or for repeat EBP (P > 0.05). Administration of cosyntropin after ADP in parturients was associated with significant reduction in the incidence of PDPH and need for EBP and significant prolongation of the time from ADP to occurrence of PDPH.

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies.

Postdural puncture headache (PDPH) is an iatrogenic complication of neuraxial blockade. We systematically reviewed the literature on parturients to determine the frequency, onset, and duration of PDPH. Citations on PDPH in the obstetrical population were identified by computerized searches, citation review, and hand searches of abstracts and conference proceedings. Citations were included if they contained extractable data on frequency, onset, or duration of PDPH. Using meta-analysis, we calculated pooled estimates of the frequency of accidental dural puncture for epidural needles and pooled estimates of the frequencies of PDPH for epidural and spinal needles. Parturients have approximately a 1.5% [95% confidence interval (CI) 1.5% to 1.5%) risk of accidental dural puncture with epidural insertion. Of these, approximately half (52.1%; 95% CI, 51.4% to 52.8%) will result in PDPH. The risk of PDPH from spinal needles diminishes with small diameter, atraumatic needles, but is still appreciable (Whitacre 27-gauge needle 1.7%; 95% CI, 1.6% to 1.8%). PDPH occurs as early as one day and as late as seven days after dural puncture and lasts 12 hr to seven days. PDPH is a common complication for parturients undergoing neuraxial blockade.

Postdural Puncture Headache After Spinal Anaesthesia in Young Orthopaedic Outpatients Using 27-G Needles

Two large studies reported a very low rate (0.5–1.8%) of postdural puncture headache (PDPH) with the use of 27-G spinal needles. We suspected that it might be higher in young ambulatory patients. The purpose of this study was to establish the rate prospectively in such a patient population using two types of needles. Two hundred male and female, outpatients, 18–45 yr, undergoing knee arthroscopy under spinal anaesthesia were randomly assigned to receive spinal anaesthesia with hyperbaric lidocaine 5% using either a Quincke or a Whitacre 27-G needle. Twenty patients choosing general anaesthesia formed a comparative group. Using a previously validated questionnaire, the incidence and nature of PDPH were evaluated by telephone three to five days after surgery by an anaesthetist unaware of the anaesthetic technique used. Once all data were collected, an anaesthetist not involved in the study determined in a blinded fashion which headaches were likely to be PDPH. Grading and classification of headaches were based on several criteria: postural nature, duration, intensity and confinement to bed. The overall incidence of PDPH in both spinal groups was 9.3%. The incidence in women, 20.4%, was higherthan in men, 5.5%, (P < 0.05). Only one patient required a blood patch. Both types of needle were comparable with respect to the incidence, severity and duration of PDPH, number of dural punctures and failed spinal blocks. The rate of PDPH was higher than in large published studies with 27-G Quincke and Whitacre needles and greater in women than in men.