ABSTRACT
Postdural puncture headache (PDPH) is the most frequent complication of procedures involving dural penetration for spinal anesthesia or following unintentional dural puncture during attempted epidural anesthesia or analgesia. PDPH causes serious problems for women who have just given birth, as they are unable to give adequate care to their infants. The causes of PDPH are poorly understood and treatments are therefore various and symptomatic; most are empirical and not all are effective. When conservative measures fail, an alternative that may be proposed is the blood patch, an invasive technique which is not without risk and which many patients reject. We report three cases of incapacitating PDPH in women after vaginal or caesarian delivery in which symptoms resolved with intravenous hydrocortisone treatment. Hydrocortisone treatment for PDPH has never been reported in the literature, but given our results, we consider that clinical trials are warranted to establish the efficacy of this treatment and to determine if there is a chance that it might offer an alternative to the blood patch.
Subject(s)
Anesthesia, Epidural , Anesthesia, Obstetrical , Anti-Inflammatory Agents/therapeutic use , Cesarean Section , Dura Mater/injuries , Headache/drug therapy , Hydrocortisone/therapeutic use , Postoperative Complications/drug therapy , Puerperal Disorders/drug therapy , Punctures/adverse effects , Acetaminophen/therapeutic use , Adult , Analgesics/therapeutic use , Anti-Inflammatory Agents/administration & dosage , Caffeine/therapeutic use , Diplopia/drug therapy , Diplopia/etiology , Female , Headache/etiology , Humans , Hydrocortisone/administration & dosage , Injections, Intravenous , Intraoperative Complications/etiology , Postoperative Complications/etiology , Pregnancy , Puerperal Disorders/etiology , Tramadol/therapeutic useABSTRACT
La cefalea postpunción dural (CPPD) es la complicación más frecuente de los procedimientos en los que se perfora la duramadre, incluyendo la anestesia subaracnoidea y la anestesia o analgesia epidural, con punción dural accidental. Constituye un cuadro especialmente grave en la puérpera, que no puede atender adecuadamente a su recién nacido. La etiología no se conoce completamente, por lo que los múltiples tratamientos propuestos son sintomáticos, en su mayoría empíricos y no siempre eficaces. Cuando las medidas conservadoras fracasan, se propone como alternativa el parche hemático, una técnica invasiva, no exenta de riesgos y que muchas pacientes rechazan. Presentamos 3 mujeres que en el puerperio inmediato desarrollaron un cuadro grave de cefalea postpunción dural, que remitió con hidrocortisona intravenosa. No está descrita la utilización de la hidrocortisona para tratar esta complicación, pero dados los resultados obtenidos, consideramos que se deberían llevar a cabo ensayos clínicos que nos permitieran establecer la efectividad de este tratamiento y precisar si, al menos en determinados casos, podría sustituir al parche hemático (AU)
