The SPG block has been used for a long time for treating headaches of varying etiologies. For anesthesiologists, treating postdural puncture headaches (PDPH) has always been challenging. The epidural block patch (EBP) was the only option until researchers explored the role of the SPG block as a relatively simple and effective way to treat PDPH.
Can post‐dural puncture headache be treated with drugs?
Post‐dural puncture headache (PDPH) is the most common side effect of a lumbar puncture. The symptom of PDPH is a constant headache that gets worse when upright and improves when lying down. Lots of drugs are used to treat PDPH, so the aim of this review was to assess the effectiveness of these drugs.
What is the character of postdural puncture headache?
The character of postdural puncture headache is throbbing and continuous. Headache does not respond to pain medications. Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. The three membranes cover brain and Spinal cord.
Does intravenous theophylline decrease post-dural puncture headaches?
Ergün U, Say B, Ozer G, Tunc T, Sen M, Tüfekcioglu S, et al. Intravenous theophylline decreases post-dural puncture headaches. J Clin Neurosci. 2008;15:1102–1104. [PubMed] [Google Scholar] 66.
What is the optimal needle gauge for postdural puncture headache (PDP)?
Postdural puncture headache. A comparison between 26- and 29-gauge needles in young patients. Anaesthesia. 1989;44:147–149. [PubMed] [Google Scholar]
How do you treat a Postdural puncture headache?
Conservative. Conservative measures for the first 24 to 48 h are considered the initial management strategy, because more than 85% of PDPH resolves with conservative treatment [33]. These measures include bed rest, intravenous hydration, caffeine supplementation, and analgesic medication.
What is a Postdural puncture headache?
PDPH Definition. The International Headache Society (IHS) defines PDPH as a headache occurring within 5 days of a lumbar puncture, caused by cerebrospinal fluid (CSF) leakage through the dural puncture. It is usually accompanied by neck stiffness and/or subjective hearing symptoms.
What helps with lumbar puncture headache?
If you experience a headache after a lumbar puncture, tell your doctor immediately as he or she may prescribe oral painkillers. Often, the headache will resolve on its own; resting, staying hydrated, and having drinks with caffeine or caffeine supplements can help relieve the pain.
Which drug is most commonly used for the treatment of a spinal headache?
Gabapentin, theophylline and hydrocortisone also proved to be effective, relieving pain better than placebo or conventional treatment alone. More people had better pain relief with theophylline (9 in 10 with theophylline compared to 4 in 10 with conventional treatment).
Why is a lumbar puncture done?
A lumbar puncture can help diagnose serious infections, such as meningitis; other disorders of the central nervous system, such as Guillain-Barre syndrome and multiple sclerosis; bleeding; or cancers of the brain or spinal cord.
How is a dural puncture diagnosed?
Symptoms of a postural headache and a history of dural puncture are usually sufficient to make a diagnosis. If in doubt, additional investigations such as MRI may be needed to confirm the clinical findings and rule out other causes of headache. MRI scanning of the brain may demonstrate evidence of reduced CSF pressure.
How do you recover from a lumbar puncture?
ActivityLying flat in bed after a lumbar puncture does not prevent you from getting a headache from the procedure.If you develop a headache after a lumbar puncture, lying flat for several hours may help.Rest when you feel tired. Getting enough sleep will help you recover.Ask your doctor when you can drive again.
What are two nursing interventions after lumbar puncture?
The nurse should note of the following nursing interventions post-lumbar puncture:Apply brief pressure to the puncture site. ... Place the patient flat on bed. ... Monitor vital signs, neurologic status, and intake and output. ... Monitor the puncture site for signs of CSF leakage and drainage of blood.More items...•
How do you prevent spinal headaches after spinal anesthesia?
To manage most spinal headaches, doctors recommend:Lying down.Drinking lots of fluids, including drinks containing caffeine (coffee, tea, and some soft drinks)Taking over-the-counter pain relievers such as ibuprofen.
What is spinal anesthesia?
Spinal anesthesia is a type of neuraxial anesthesia; local anesthetic (LA) is injected into cerebrospinal fluid (CSF) in the lumbar spine to anesthetize nerves that exit the spinal cord.
Is a lumbar puncture the same as an epidural?
Like the lumbar puncture procedure, placing an epidural requires learning how to properly insert the needle using ultrasound or anatomical landmarks. Unlike the LP, placing an epidural is a procedure completed only by certain specialties, such as Anesthesia or Pain Medicine.
What is post lumbar puncture syndrome?
Post-lumbar puncture syndrome (PLPS) is a frequent and important complication of diagnostic lumbar puncture. PLPS is primarily caused by perforation of the dura mater, leading to persistent leak of the cerebrospinal fluid, and, as a result, intracranial hypotension.
What is PDPH after anesthesia?
PDPH is an adverse iatrogenic complication of neuraxial anesthesia that occurs following inadvertent puncture of the dura after epidural or spinal anesthesia. The overall incidence of PDPH after neuraxial procedures varies from 6 to 36%.
How long does it take for a PDPH headache to go away?
PDPH is a self-limiting postural headache that most often will resolve within 1 week, without need for treatment. Various prophylactic measures have been studied; however, more studies have been recommended to be undertaken in order to establish a proven benefit.
INTRODUCTION
Postural headaches following interventions that disrupt meningeal integrity are most commonly labeled postdural puncture headaches (PDPHs). This terminology has been officially adopted in the International Classification of Headache Disorders and is used in this section.
HISTORY AND CURRENT RELEVANCE
As one of the earliest recognized complications of regional anesthesia, PDPH has a long and colorful history. Dr. August Bier noted this adverse effect in the first patient to undergo successful spinal anesthesia on August 16, 1898 ( Figure 1 ).
PATHOPHYSIOLOGY
It has long been accepted that PDPH results from a disruption of normal CSF homeostasis. However, despite a great deal of research and observational data, the pathophysiology of PDPH remains incompletely understood.
CLINICAL PRESENTATION AND CHARACTERISTICS
Although many clinical variations have been described, most cases of PDPH are characterized by their typical onset, presentation, and associated symptoms.
RISK FACTORS
Risk factors for PDPH can be broadly categorized into patient characteristics and procedural details.
PREVENTION
Although prophylaxis is most simply thought of as preventing any symptoms of PDPH, in the clinical context this issue is deceptively complex. It is important to appreciate that significant “prevention” may encompass a number of other endpoints, such as a reduced incidence of severe PDPH, a shorter duration of symptoms, or decreased need for EBP.
DIAGNOSTIC EVALUATION
Postdural puncture headache remains a diagnosis of exclusion. Although headache following meningeal puncture will naturally be suspected to be PDPH, it remains critical to rule out other etiologies ( Table 1 ).
What is a headache caused by a dural puncture?
Such headache caused by dural puncture is known as Postdural puncture headache. The loss of cerebrospinal fluid decreases pressure within subarachnoid space, which is expressed with symptoms like severe pounding headache. Dural puncture can be minor or major.
What causes a postural puncture headache?
Postdural puncture headache is caused by continuous leakage of cerebrospinal fluid from laceration, crack or hole in dural membrane. The three membranes cover brain and Spinal cord. Cerebrospinal fluid lies between 2nd and 3rd layer of membrane, also known as mater. The 3 membranes are known as pia, arachnoid and dura mater.
How is spinal anesthesia performed?
Spinal Anesthesia- Spinal anesthesia is performed by placing needle in subarachnoid space. The local anesthesia is injected through the needle in to subarachnoid space. In few cases multiple attempts are made to place needle in epidural space. The dural puncture causes tiny hole in dura and subarachnoid mater, which closes immediately after removal of needle because of retraction of elastic fibers of membrane. In few cases less than 0.1% the hole does not close and CSF leak continues. The continuous leak of CSF results in symptoms of headache.
Why does the dural puncture close?
The dural puncture causes tiny hole in dura and subarachnoid mater, which closes immediately after removal of needle because of retraction of elastic fibers of membrane. In few cases less than 0.1% the hole does not close and CSF leak continues. The continuous leak of CSF results in symptoms of headache.
Where is the drop of pressure in the subarachnoid space?
Thus the drop of pressure within subarachnoid space is observed in spinal cord as well as brain. Sudden drop of pressure within subarachnoid space covering brain which is enclosed in skull also affects the outline of vessels like arteries, veins and lymphatics.
Introduction
History and Current Relevance
Pathophysiology
Clinical Presentation and Characteristics
Risk Factors
Prevention
Diagnostic Evaluation
- Postdural puncture headache remains a diagnosis of exclusion. Although headache following meningeal puncture will naturally be suspected to be PDPH, it remains critical to rule out other etiologies (Table 1). Fortunately, a careful history with a brief consideration of other possible diagnoses is usually all that is necessary to differentiate PDPH ...
Treatment
Persistent Or Recurrent PDPH
When to Seek Further Consultation