Prevention Of Post-dural Puncture Headache Research Articles

Role of Cosyntropin in the Prevention of Postdural Puncture Headache: A Propensity-matched Retrospective Analysis

Role of Cosyntropin in the Prevention of Postdural Puncture Headache: A Propensity-matched Retrospective Analysis

Post spinal puncture headache: diagnosis, risk factors and treatment

Spinal anesthesia is one of the most used anesthetic techniques, having been in existence for over 100 years, and over time it has been improved by the development of a new needle design, gauge, tip shapes, as well as more precise indications and contraindications. However, even so, there are still possible complications due to this procedure, especially headache after puncture of the dura mater, and, because of that, this procedure carries with it a great increase of taboos and prejudices. Although it is clear that reducing the size of the dural perforation reduces CSF loss, thus making the incidence of headache less likely, there are many other issues to be clarified regarding the pathophysiology, treatment and prevention of post-dural puncture headache. How does needle design, size, and orientation influence CSF leakage through dural perforation? Can pharmacological methods reduce symptoms of post-dural puncture headache? Can epidural blood patch help in the treatment of post-spinal anesthesia headache? Can epidural blood patch act prophylactically? Does epidural saline solution reduce the rate of CSF loss? Thus, this article aims to answer these questions according to the most recent studies and make an objective review of post spinal anesthesia headache with an approach to pathophysiology, diagnosis, clinical scenario, risk factors, prevention and therapeutic options.

Role of cosyntropin in the prevention of post-dural puncture headache: a propensity-matched retrospective analysis

BackgroundPost-dural puncture headache (PDPH) is a well-documented complication of accidental dural puncture in obstetric patients. Reports have shown successful treatment with adrenocorticotropic hormone (ACTH) but evidence remains low and limited. In this retrospective analysis, we assessed whether prophylactic administration of cosyntropin, a synthetic derivative of ACTH, reduced the incidence of PDPH after accidental dural puncture in parturients. MethodThe study population included 132 women with an accidental dural puncture over a three-year period (June 1, 2018 to Oct 31, 2021) at a large tertiary-care center. Patient electronic medical records were reviewed for patient characteristics, prophylactic administration of cosyntropin, PDPH diagnosis, and need for epidural blood patch. Typically, 1 mg of cosyntropin was administered as an intravenous bolus or infusion post-delivery. The propensity score was calculated based on the following factors: age, body mass index, and placement of an intrathecal catheter. Patients were matched allowing 10% variation in scores to reduce potential treatment assignment bias. ResultsA total of 115 patients were included in the final analysis. Intravenous cosyntropin was administered to 65 patients (55.6%). Among those who received cosyntropin, 37 (56.9%) developed PDPH compared with 29 patients (58%) in the no-cosyntropin group (P = 0.08). Epidural blood patch was performed in 21 patients (56.8%) who received cosyntropin and 13 patients (61.7%) who did not (P = 0.70). ConclusionProphylactic administration of cosyntropin is not associated with a reduced incidence of PDPH.

Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis

BackgroundAccidental dural puncture is a common complication of labour analgesia. It can trigger post-dural puncture headache, with associated morbidity and increased costs. Intrathecal catheter placement is a prophylactic procedure which can reduce incidence and severity of post-dural puncture headache.MethodsWe conducted a retrospective single-centred study to define incidence and risk factors of accidental dural puncture and post-dural puncture headache in an obstetric population. We also evaluated effectiveness of intrathecal catheter placement compared to epidural catheter replacement in reducing incidence of post-dural puncture headache. We then conducted a systematic review and meta-analysis which included all studies comparing intrathecal catheter placement to epidural catheter replacement in obstetric patients with accidental dural puncture assessing the outcome of reduced incidence of post-dural puncture headache as a dichotomous variable.ResultsAccidental dural puncture had an incidence of 0.25% (60 cases). Of these, 66% developed post-dural puncture headache. A total of 77% (47/60) of patients with accidental dural puncture were treated with an intrathecal catheter placement, while 23% (13/60) had an epidural catheter replacement. Incidence of post-dural puncture headache was lower in the intrathecal catheter group (spinal 26/47, 60.5% epidural 11/13, 84.6%), although not reaching statistical significance (RR 0.71, CI 95%: 0.51–1.00; p = 0.049). The meta-analysis revealed that intrathecal catheter placement significantly reduced incidence of post-dural puncture headache compared to epidural catheter replacement (pooled RR 0.81, 95% CI 0.72–0.91, p < 0.001).ConclusionsIntrathecal catheter placement is a promising measure to prevent post-dural puncture headache, especially if followed by a pain management protocol and a continuous saline infusion.

Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture.

No convincing modalities have been shown to completely prevent postdural puncture headache (PDPH) after accidental dural puncture (ADP) during obstetric epidural procedures. We aimed to evaluate the role of epidural administration of hydroxyethyl starch (HES) in preventing PDPH following ADP, regarding the prophylactic efficacy and side effects. Between January 2019 and February 2021, patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital. The development of PDPH, severity and duration of headache, adverse events associated with prophylactic strategies, and hospital length of stay postpartum were reported. A total of 105 patients experiencing ADP received a re-sited epidural catheter. For PDPH prophylaxis, 46 patients solely received epidural analgesia, 25 patients were administered epidural HES on epidural analgesia, and 34 patients received two doses of epidural HES on and after epidural analgesia, respectively. A significant difference was observed in the incidence of PDPH across the groups (epidural analgesia alone, 31 [67.4%]; HES-Epidural analgesia, ten [40.0%]; HES-Epidural analgesia-HES, five [14.7%]; P <0.001). No neurologic deficits, including paresthesias and motor deficits related to prophylactic strategies, were reported from at least 2 months to up to more than 2 years after delivery. An overall backache rate related to HES administration was 10%. The multivariable regression analysis revealed that the HES-Epidural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP (OR = 0.030, 95% confidence interval: 0.006-0.143; P < 0.001). The incorporated prophylactic strategy was associated with a great decrease in the risk of PDPH following obstetric ADP. This strategy consisted of re-siting an epidural catheter with continuous epidural analgesia and two doses of epidural HES, respectively, on and after epidural analgesia. The efficacy and safety profiles of this strategy have to be investigated further.

RISK FACTORS, CLINICAL MANIFESTATION AND PREVENTION OF POST-DURAL PUNCTURE HEADACHE IN THE OBSTETRIC FIELD

Introduction: Over the past decades, the number of wo­men choosing to have epidural analgesia or undergoing spinal anesthesia during labor is steadily increasing. Con­sequently, a risk for complications is increasing. Post-dural puncture headache (PDPH) is considered one of the most common complication following accidental dural puncture (ADP). Sources and a method: A literature overview were con­ducted via search engine “PubMed (Medline)” and “Goo­gle Scholar”. Randomized controlled trials, meta – analy­sis, retrospective, prospective trials and systemic reviews on PDPH were selected. Aim of the review: To evaluate the most commonly des­cribed risk factors, clinical presentation and prevention of PDPH in the obstetric field. Results: The occurrence of ADP during neuraxial anest­hesia reported in the literature is relatively small – 0,1 – 1,5%. PDPH is a potentially expected complication after any lumbar punction. It presents as a headache within five days of the puncture due to low cerebrospinal fluid pressure. The pain is often bilateral, located in the frontal or occipital areas. Symptoms, such as vision and hearing impairment, neck pain and nausea might follow. Usually, the symptoms fade out spontaneously within two weeks. Risk factors for PDPH are modifiable (technique of the injection and anesthesiologist’s skills) and non-modifia­ble (pregnancy, low body mass index (BMI), dehydra­tion, history of PDPH). The goal of preventing PDPH is to identify and correct the risk factors associated with this condition. Main described means being equipment and experience, conservative measures, administration of epidural morphine, intravenous dexamethasone or co­syntropin, epidural blood patch and intrathecal catheter. Conclusions: 1. PDPH manifests as an orthostatic hea­dache with or without ocular, neural, hearing and other symptoms. 2. Young pregnant women with low BMI are more likely to suffer from PDPH. 3. PDPH preven­tion consists of risk factor correction and proper medi­cal techniques.

Restrictive versus liberal perioperative fluid strategies to prevent post-dural puncture headache after cesarean delivery

BackgroundPost-dural puncture headache is a common complication after cesarean delivery. The role of fluid therapy in prevention of post-dural puncture headache is not clear. The aim of this work is to compare restrictive versus liberal perioperative fluid protocols in prevention of post-dural puncture headache. A randomized controlled trial was conducted including 100 full-term pregnant women undergoing cesarean delivery under spinal block. After receiving spinal block, all patients received 1.5 mcg/kg phenylephrine and crystalloid co-load at a rate of 10 mL/h. Patients were assigned into either restrictive group (did not receive fluid preload + received postoperative crystalloid therapy at a rate of 2 mL/kg/h till resuming oral fluids) or liberal group (received crystalloid preload 5 mL/kg before spinal block + received postoperative crystalloids at a rate of 6 mL/kg/h till resuming oral fluids. Both groups were compared according to the incidence of post-dural puncture headache, pain scores, systolic blood pressure, heart rate, incidence of post-spinal hypotension, nausea, and vomiting.ResultsThe incidence of post-dural puncture headache was lower in the restrictive group compared to the liberal group {10(20%) vs 22(44%), P = 0.018}. All other secondary outcomes were comparable between both groups.ConclusionRestrictive fluid therapy was associated with lower incidence of PDPH after cesarean delivery without impacting patient hemodynamic profile.

Prophylactic Intrathecal Morphine and Prevention of Postdural Puncture Headache: A Randomized Double-blind Trial

(Anesthesiology. 2020;132:1045–1052) Postdural puncture headache (PDPH) occurs in 50% to 80% of patients who experience an unintentional dural puncture (UDP). PDPH can cause maternal morbidity and lengthen maternal hospital stay. There is no established method of preventing PDPH after UDP. One trial found epidural morphine reduced PDPH rate from 48% with placebo to 12%. There is concern that epidural morphine with a large dural tear could put patients at higher risk of respiratory depression. The use of an intrathecal catheter after UDP is common in many obstetric care centers. This study evaluated the effects of intrathecal morphine after UDP on the incidence and severity of PDPH in obstetric patients.

The Effect of Intrathecal Administration of Different Doses of Morphine on Headache after Dural Puncture in Cesarean Sections Under Spinal Anesthesia: A Randomized Double-Blind Controlled Study

Introduction: Intrathecal morphine is used to prevent post-dural puncture headache (PDPH). We aimed to investigate the effect of administering different doses of morphine intrathecally on PDPH in whom a cesarean section (CS) was performed under spinal anesthesia. Materials and Methods: 80 ASA I-II pregnant women were included in the study. They were randomly divided into four groups: F25: 2ml of hyperbaric bupivacaine+25µg of fentanyl intrathecally, M100: 2ml of hyperbaric bupivacaine +100µg of morphine intrathecally, M150: 2ml of hyperbaric bupivacaine+150µg of morphine intrathecally and M200: 2ml of hyperbaric bupivacaine+200µg of morphine intrathecally. The patients were monitored for postoperative headache, development of PDPH, the requirement for epidural blood patch (EBP), the EBP number, the duration of hospitalization, and side effects that might occur within the first 24 hours (drug allergy, nausea, vomiting, itching, apnea, desaturation). All patients were assessed using the visual analog scale (VAS) for seven days postoperatively. Results: The lowest rate of PDPD was determined in the M200. The highest VAS score of M200 was significantly lower than the other groups (p

Effects of Dexamethasone on Post-dural Puncture Headache in Patients Undergoing Orthopedic Surgery

Background: The effect of Dexamethasone on Post-Dural Puncture Headache (PDPH) after spinal anesthesia has not been well elucidated. The aim of the current study was to evaluate the effect of prophylactic intravenous dexamethasone on the incidence and severity of PDPH in patients undergoing orthopedic surgery. Methods: This randomized, double-blind, placebo-controlled trial was carried out in patients undergoing orthopedic surgery. The subjects were randomly divided into a placebo (n=140) and a dexamethasone (n=140) group. During the surgery, the control group participants were injected 2cc of distilled water, and the dexamethasone group participants were injected 2cc (8mg) of dexamethasone as an infusion in the veins. The incidences of PDPH on the first, third and seventh postoperative days were studied. Data were analyzed using SPSS version 22. Results: A total of 280 patients with a mean age of 32.7 ± 11.0 years were studied. The incidence of PDPH on the first day of post-operative period was lower in the dexamethasone group than the control group (21 vs. 34, P&lt;0.05). This difference was disappeared on days 3 and 7. Nausea or vomiting occurred less in the dexamethasone group (9 vs. 26, P&lt;0.05). However, no statistically significant association was found between study groups and the incidence of back pain (P&gt;0.05). Conclusion: Although the frequency of PDPH was less in patients receiving dexamethasone, the incidence increased days after the operation and reached the level of the placebo group. We do not recommend prophylactic intravenous dexamethasone for the prevention of PDPH.

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&gt;0.05). Mean severity, onset time, and duration of PDPH were not significantly different between the two groups (P&lt;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&gt;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&lt;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.

Prevention of post-dural puncture headache: a randomized controlled trial.

We investigated 952 subjects undergoing diagnostic lumbar puncture (LP) to study the effects of needle size, needle design and stylet reinsertion on the risk of post-dural puncture headache (PDPH). This randomized double-blind study was performed at Umeå University Hospital in Sweden during 2013-2018. Subjects were randomly assigned one of three needles [22 gauge (G) atraumatic, 25G atraumatic and 25G cutting] and stylet reinsertion before needle withdrawal or not. The main outcome measure was PDPH assessed by standardized telephone interview(s) 5days after the LP, repeated until headache cessation. We used logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CI) for PDPH. The mean (SD) age was 51.1 (16.7) years and 53.6% were females. The smaller bore (25G) atraumatic needle incurred a lower risk of headache compared with the larger bore (22G) atraumatic needle [22.0% (69/314) vs. 30.2% (98/324); OR, 0.65; 95% CI, 0.45-0.93] and compared with the cutting needle [32.8% (103/314); OR, 0.58; 95% CI, 0.40-0.82]. Reinserting the stylet before needle withdrawal did not reduce the risk of headache. These data suggest that a 25G atraumatic needle is superior to a larger atraumatic needle, and to a same-sized cutting needle, in preventing PDPH after diagnostic LP. In contrast to one earlier report, this study did not find that stylet reinsertion was effective in preventing PDPH. This study provides class I evidence that a small atraumatic needle decreases the risk of PDPH and that stylet reinsertion does not influence PDPH risk.

Evaluation of prophylactic intravenous hydrocortisone for the prevention of postdural puncture headache following spinal anesthesia for cesarean section

Context: Postdural puncture headache (PDPH) is a common complication following spinal anesthesia. No medication is currently used on routine basis for its prevention despite its high incidence. Aims: This study evaluated the efficacy of prophylactic intravenous (IV) hydrocortisone 100 mg in reducing the incidence and severity of PDPH among obstetric patients who had spinal anesthesia for cesarean delivery. Study Design: This study is a double-blind, randomized controlled trial in which 400 consenting parturients having cesarean section under spinal anesthesia were randomized into two groups; hydrocortisone and control groups. Following delivery, patients in the hydrocortisone group received IV hydrocortisone 100 mg diluted to 2 ml while those in the control group received the same volume of 0.9% saline. Patients were reviewed for the occurrence of PDPH over 5 days and headache severity assessed using the numerical rating scale. Intraoperative and postoperative side effects of single-dose hydrocortisone were also documented. Statistical Analysis: Data were analyzed using SPSS 20 software. A P

The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies

(Reg Anesth Pain Med. 2018;43:502–508) As the use of neuraxial anesthesia is potentially broadening, an increased understanding and prevention of postdural puncture headache (PDPH) is needed. While numerous studies have examined either needle gauge or design, there has not been a comprehensive study analyzing individual technical and patient-related factors. This meta-analysis aimed to examine the association between spinal needle characteristics and PDPH.

Prevention of postdural puncture headache after accidental dural puncture in cesarean sections: a comparative study

Background Accidental dural puncture (ADP) is one of the most common complications of neuraxial anesthesia in labor with high incidence of postdural puncture headache (PDPH). Aim Primary outcome: to compare the effectiveness of intramuscular neostigmine, intrathecal catheterization (ITC), epidural blood patch (EBP) on the prevention of PDPH. Secondary outcome: to assess the severity of PDPH and possible complications. Patients and methods One hundred and twenty patients exposed to ADP, fulfilling the inclusion criteria were divided into four equal groups. Control group: received conservative treatment when developed PDPH with a visual analog scale (VAS) of more than 4, group N: received intramuscular neostigmine 20 µg/kg and atropine 0.01 mg/kg after ADP, group ITC: ITC at the same site of ADP and left for 48 h and group EBP: received EBP at a level of ADP. VAS was assessed at 6, 12, 24, 36, and 24 h. Pain severity was divided into no pain (VAS 7). Number of patients who required rescue ketorolac analgesia and average diclofenac (mg) consumption during the first 48 h and possible complications were recorded. Results VAS score and pain severity were significantly higher in the control group than other groups, in group N and group ITC than EBP and in group N than group ITC at all examination times. The number of patients who required diclofenac analgesia was significantly higher in the control group than other groups. Average diclofenac consumption during the first 48 h was significantly higher in the control group than other groups, in both group ITC and group N than EBP and in group N than group ITC. Urinary bladder spasm, hypotension, and bradycardia were significantly higher in group N than other groups, and muscle twitching and abdominal cramps were significantly higher in group N than both control and EBP groups. Conclusion EBP was superior to ITC and neostigmine in reducing the incidence of PDPH and pain severity with less complications.

Insertion of an intrathecal catheter following a recognised accidental dural puncture reduces the need for an epidural blood patch in parturients: an Australian retrospective study

BackgroundThere is no clear consensus about how best to prevent post-dural puncture headache (PDPH) following an accidental dural puncture in parturients. Our primary objective was to investigate whether the insertion of an intrathecal catheter following accidental dural puncture reduces the incidence of PDPH and therapeutic epidural blood patch. MethodsAnaesthetic records from January 2009 to December 2015 were reviewed retrospectively and parturients who had an accidental dural puncture and/or PDPH were identified. Data from those with a recognised dural puncture in whom an intrathecal catheter was inserted at the time of accidental dural puncture (ITC group) were compared to those without an intrathecal catheter (non-ITC group), as were outcomes of patients with an intrathecal catheter for ≥24 hours compared to <24 hours. ResultsOf 94 recognised accidental dural punctures, 66 were in the ITC group (37 for ≥24 h) and 28 in the non-ITC group. In the ITC group, 22 (33.3%) required an epidural blood patch in comparison to 19 (67.9%) in the non-ITC group (P <0.01, 95% CI 12.5 to 52.0). In the ITC group, 62 (93.9%) developed PDPH in comparison to 28 (100%) in the non-ITC group (P=0.186, 95% CI −6.55 to 14.57). Intrathecal catheter insertion for ≥24 h obviated the need for an epidural blood patch in 28 (75.7%) parturients, compared to 13 (59.1%) if <24 h (P=0.184, 95% CI −7.08 to 39.72). ConclusionInserting an intrathecal catheter after a recognised accidental dural puncture significantly reduced the need for an epidural blood patch.

Needle gauge and tip designs for preventing post-dural puncture headache (PDPH).

Post-dural puncture headache (PDPH) is one of the most common complications of diagnostic and therapeutic lumbar punctures. PDPH is defined as any headache occurring after a lumbar puncture that worsens within 15 minutes of sitting or standing and is relieved within 15 minutes of the patient lying down. Researchers have suggested many types of interventions to help prevent PDPH. It has been suggested that aspects such as needle tip and gauge can be modified to decrease the incidence of PDPH. To assess the effects of needle tip design (traumatic versus atraumatic) and diameter (gauge) on the prevention of PDPH in participants who have undergone dural puncture for diagnostic or therapeutic causes. We searched CENTRAL, MEDLINE, Embase, CINAHL and LILACS, as well as trial registries via the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal in September 2016. We adopted the MEDLINE strategy for searching the other databases. The search terms we used were a combination of thesaurus-based and free-text terms for both interventions (lumbar puncture in neurological, anaesthesia or myelography settings) and headache. We included randomized controlled trials (RCTs) conducted in any clinical/research setting where dural puncture had been used in participants of all ages and both genders, which compared different tip designs or diameters for prevention of PDPH DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. We included 70 studies in the review; 66 studies with 17,067 participants were included in the quantitative analysis. An additional 18 studies are awaiting classification and 12 are ongoing. Fifteen of the 18 studies awaiting classification mainly correspond to congress summaries published before 2010, in which the available information does not allow the complete evaluation of all their risks of bias and characteristics. Our main outcome was prevention of PDPH, but we also assessed the onset of severe PDPH, headache in general and adverse events. The quality of evidence was moderate for most of the outcomes mainly due to risk of bias issues. For the analysis, we undertook three main comparisons: 1) traumatic needles versus atraumatic needles; 2) larger gauge traumatic needles versus smaller gauge traumatic needles; and 3) larger gauge atraumatic needles versus smaller gauge atraumatic needles. For each main comparison, if data were available, we performed a subgroup analysis evaluating lumbar puncture indication, age and posture.For the first comparison, the use of traumatic needles showed a higher risk of onset of PDPH compared to atraumatic needles (36 studies, 9378 participants, risk ratio (RR) 2.14, 95% confidence interval (CI) 1.72 to 2.67, I2 = 9%).In the second comparison of traumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH, with the exception of one study comparing 26 and 27 gauge needles (one study, 658 participants, RR 6.47, 95% CI 2.55 to 16.43).In the third comparison of atraumatic needles, studies comparing various sizes of large and small gauges showed no significant difference in effects in terms of risk of PDPH.We observed no significant difference in the risk of paraesthesia, backache, severe PDPH and any headache between traumatic and atraumatic needles. Sensitivity analyses of PDPH results between traumatic and atraumatic needles omitting high risk of bias studies showed similar results regarding the benefit of atraumatic needles in the prevention of PDPH (three studies, RR 2.78, 95% CI 1.26 to 6.15; I2 = 51%). There is moderate-quality evidence that atraumatic needles reduce the risk of post-dural puncture headache (PDPH) without increasing adverse events such as paraesthesia or backache. The studies did not report very clearly on aspects related to randomization, such as random sequence generation and allocation concealment, making it difficult to interpret the risk of bias in the included studies. The moderate quality of the evidence for traumatic versus atraumatic needles suggests that further research is likely to have an important impact on our confidence in the estimate of effect.

Prevention of Postdural Puncture Headache Following Accidental Dural Puncture: Two Cases Report and Mini Literature Review

Prevention of Postdural Puncture Headache Following Accidental Dural Puncture: Two Cases Report and Mini Literature Review

Aminophylline does not Prevent Postdural Puncture Headache in Caesarean Section

Aminophylline does not Prevent Postdural Puncture Headache in Caesarean Section

A new approach using high volume blood patch for prevention of post-dural puncture headache following intrathecal catheter pump exchange.

Background:In an observational study, complications of intrathecal catheter pumps necessitating surgical exchange were analyzed. Also the use of a high-volume prophylactic epidural blood patch (EBP) during surgery for preventing post-dural puncture headache (PDPH) with a follow-up for 1 year is described.Materials and Methods:In 22 patients with refractory chronic pain of cancer/noncancer origin or severe spasticity, who were receiving intrathecal morphine including adjuvants or baclofen for symptom relief, catheter exchange with or without pump was performed. In patients with documented symptoms of PDPH following initial intrathecal catheter implantation, a prophylactic EBP with a high blood volume was used for PDPH prevention during surgery. Catheters were replaced using 40 mL EBP before entering dural space at a speed of 5mL/min into the epidural space. Patients were asked to quantify pain experience and functional ability.Results:From a sample of 72 patients admitted for catheter exchange with or without pump, 22 patients (33%) (12 male, 10 female) had a history of PDPH following initial implantation. Diagnostic and therapeutic measures occurring with malfunction of intrathecal catheter pump systems were described. Twenty-one patients were successfully treated with prophylactic EBP, while one patient could not be properly evaluated because of intracranial bleeding as the underlying disease.Conclusions:A new approach using a high-volume prophylactic EBP for preventing PDPH following catheter exchange is presented. The efficacy and safety of this technique for 1 year follow-up have been evaluated and was found to be safe and potentially effective.