ABSTRACT
Background: Post-dural puncture headache (PDPH), formerly known as post-lumbar puncture headache, is a well-known adverse event that follows diagnostic and/or therapeutic puncture of the dura, or accidentally, following spinal anesthesia. Material & Methods: This prospective study was carried out on 152 patients at Shaheed Ziaur Rahman Medical College Hospital in Bogura, from 2013 to 2015 and North Bengal Medical College from 2016 to 2022, Bangladesh. Results: A total of 152 patients were enrolled into the study where 122(80.3%) were aged between 18-28 years, 30(19.7%) were 29-39 years, 38(25%) were male and 114(75%) were female. 122(80.3%) patients were non obese (<25) and 30(19.7%) were obese (>25). 17(11.2%) patients had previous history of anaesthesia and 17(11.2%) had previous history of PDPH. On majority 100 patients were used big size needle (18-23 G) and rest of the patients were used small (23-25G). 146 (96.1%) patients position was lateral and 92(60.5%) were used less than two or equal three drops. 61(40.1%) patients were needed one attempt, 64(42.1%) were needed two and 27(27.8%) were needed greater than two. The prevalence of PDPH was found in 44(28.9%) cases out of 152 where severity of 29(65.9%) percent was mild, 20(45.5%) cases headache onset were at the first day and mean duration of headache was 2.6. There was a statistically significant association between development of PDPH and younger age (26.3±8.7 years vs 32.6±7.4, p< 0.001), female gender (p=00.009), previous history of PDPH (p<0.001), number of attempts (3.1±1.2 vs 1.2±0.8, p<0.001), small needles (p=0.04), pre LP headache (p<0.001) and CSF RBS (2.6±2.1 vs 13.8±1.3, p= 0.48). Conclusion: This study recommends that the neurologists should be treating this population in the manner so that it may help to prevent this painful adverse event, and identification of risk variables is vital in predicting PDPH.
ABSTRACT
To treat the patient who developed post-dural puncture headache (PDPH) after the epidural anesthesia for painless delivery or spinal subarachnoid anesthesia for caesarean section, we provided a combination therapy with Kampo medicines goshuyuto and ryokeijutsukanto (39 patients), and a single therapy with goshuyuto (17 patients). We compared the patients based on the improvement rate and the average of the differences of Numerical Rating Scale (NRS) before and after taking Kampo medicines. Of 39 patients treated with combination therapy, 82.1% were effective in the improvement rate, and 74.4% were effective in NRS differences. Of 17 patients treated with goshuyuto alone, 58.8% was effective in the improvement rate, and 41.2% in NRS differences. In the improvement rate, it was insignificant (p=0.094). However, in the comparison of the average of the NRS differences, the combination therapy was significantly more effective than with from goshuyuto alone (p=0.032) (p<0.05). There was no significant difference depending on when the administration was started. It was suggested that a combination therapy with goshuyuto and ryokeijutsukanto is effective and convenient for PDPH.
ABSTRACT
Abstract Background and objectives: Neurological complications of spinal anesthesia are rare conditions. Headache caused by low pressure of the cerebrospinal fluid is one of the most frequent, which occurs after post-dural puncture. A comprehensive history and physical exam must be carried out before making the diagnosis of Post-Dural Puncture Headache (PDPH) and additional tests are necessary to exclude the possibility of developing serious neurological complications such as Dural Sinus Thrombosis (DST). According to the Case Report a differential diagnosis between Dural Sinus Thrombosis with PDPH is discussed. Case report: A 22 year-old lady, ASA Physical Status Class I was admitted at 39 weeks of gestation for delivery. For labor pain relief she requested epidural for analgesia, but unfortunately accidental dural puncture occurred. She developed an occipital headache and neck pain in the second day postpartum which was relieved by both lying down and supporting treatment such as rehydration, analgesics and caffeine. On day third postpartum she was discharged without complaints. On day fifth postpartum the pain returned and became more intense and less responsive to oral analgesics. She was admitted to the hospital to do a complete neurological and image investigation that showed a lesion consistent with the diagnosis of cortical vein thrombosis and Dural Sinus Thrombosis (DST). She was treated with oral anticoagulants. After two days, a repeated magnetic resonance image (MRI) showed partial canalization of the central sinus thrombus. The patient was discharged from hospital five days after her admission without any of the initial symptoms. Conclusion: The report describes a patient who developed severe headache following continuous epidural analgesia for delivery. Initially it was diagnosed as PDPH, however with the aid of MRI the diagnosis of DST was later established and treated. DST is a rare condition and is often underdiagnosed. Because of its potentially lethal complications, it should always be considered in acute headache differential diagnosis.
Resumo Justificativa e objetivos: As complicações neurológicas da raquianestesia são condições raras. A cefaleia causada pela baixa pressão do fluido cerebrospinal é uma das mais frequentes e ocorre após a punção dural. Anamnese completa e exame físico geral devem ser feitos antes de fazer o diagnóstico de cefaleia pós-punção dural (CPPD) e testes adicionais são necessários para excluir a possibilidade de complicações neurológicas graves, como trombose de seios durais (TSD). De acordo com o relato do caso, discutiremos o diagnóstico diferencial entre TSD e CPPD. Relato de caso: Paciente de 22 anos, estado físico ASA I, foi admitida com 39 semanas de gestação para o parto. Para alívio da dor do trabalho de parto, a paciente solicitou analgesia peridural, mas infelizmente ocorreu uma punção dural acidental. A paciente desenvolveu cefaleia occipital e dor cervical no segundo dia pós-parto - ambas aliviadas com repouso e terapia de suporte, como reidratação, analgésicos e cafeína. No terceiro dia pós-parto, a paciente recebeu alta sem queixas. No quinto dia pós-parto, a dor retornou e ficou mais intensa e com pouca resposta aos analgésicos orais. Ela foi admitida no hospital para uma completa investigação neurológica e de imagem que mostrou uma lesão compatível com o diagnóstico de trombose venosa cortical e TSD. A paciente foi tratada com anticoagulantes orais. Após dois dias, a repetição de ressonância nuclear magnética (RM) mostrou canalização parcial de trombo do seio central. A paciente recebeu alta hospitalar cinco dias após a admissão, sem quaisquer dos sintomas iniciais. Conclusão: O caso descreve uma paciente que desenvolveu cefaleia grave após epidural contínua para o parto. Inicialmente ela foi diagnosticada como CPPD, contudo com o auxílio da RNM foi estabelecido o diagnóstico tardio de TSD. TSD é uma condição rara e frequentemente subdiagnosticada. Ela deve sempre ser considerada como diagnóstico diferencial de cefaleia aguda em decorrência de suas complicações potencialmente letais.
Subject(s)
Humans , Female , Pregnancy , Sinus Thrombosis, Intracranial/diagnosis , Post-Dural Puncture Headache/diagnosis , Anesthesia, Epidural/instrumentation , Caffeine/administration & dosage , Analgesics/administration & dosageABSTRACT
Aim: To evaluate the efficacy of oral Theophylline for the management of post dural puncture headache (PDPH). Material and Method: Forty patients with PDPH, whose surgeries were done under spinal anaesthesia, were selected randomly and divided into two groups of 20 each. One group to receive conservative treatment and the other group Theophylline (400 mg) only orally. Intensity of headache was analysed using a visual analogue scale (VAS) of pain. Assessment was done immediately before (0 h) and at 8, 16 and 24th hr of drug administration. Result: Significantly better relief of PDPH was found in Theophylline (9.3±5.7) than the conservative group (56.7 ±10.2) (p<0.001). Recurrence of headache was found in 2 patients (10 %) at16th hr and 2 (10%) at 24th hr in the Theophylline group compared to 12 (60%) and 14 (70%) patients respectively in the other group. Conclusion: The study concludes that Theophylline in the management of post dural puncture headache may be considered the best choice over the conventional approach.
ABSTRACT
BACKGROUND: Several reports have indicated that there are fewer postoperative complications after using a smaller spinal needle in young patients. However, no comparative report has been issued on the incidences of postoperative complications after using differently sized spinal needles for spinal anesthesia in elderly patients. Here, we compared a 22 G Quincke needle with a 25 G Quincke needle in elderly patients and investigated postoperative complications. METHODS: Fifty patients, aged over 60 years presented for an elective urological operation. Patients were randomized into two groups to receive spinal anesthetics using a 22 G Quincke needle (group L) or a 25 G Quincke needle (group S). The incidences of postdural puncture headache (PDPH), backaches, and the outcomes of spinal anesthesia were compared between the two groups. RESULTS: Two patients in group L and one in group S developed PDPH postoperatively with no significant statistical difference between the two groups. Four patients suffered backache in group L and two in group S again without significance. But the number of puncture attempts was significantly higher in group S. CONCLUSION: In conclusion, postoperative complications were similar for both groups. However, spinal anesthesia was performed more easily when using a larger spinal needle. Therefore, we recommend that a larger spinal needle be used when difficult spinal anesthesia is anticipated in elderly patients.