Management of an Uncorrected Tetralogy of Fallot for Caesarean Section Using Low-Dose Combined Spinal Epidural Anaesthesia Under Advanced Haemodynamic Monitorization.

Since management of parturients with uncorrected tetralogy of Fallot reported until now lacks advanced cardiac haemodynamic monitoring, we aimed to present anaesthetic management of a parturient with uncorrected tetralogy of Fallot scheduled for caesarean section by addressing the challenges in the management based on the advanced haemodynamic monitoring due to the expected high-risk maternal morbidity and mortality in this particular case. Hereby, we provided haemodynamic stability with little requirement for vasopressor medication by using low-dose combined spinal epidural anaesthesia in a parturient with uncorrected tetralogy of Fallot scheduled to undergo caesarean delivery.

Bilateral greater occipital nerve block for treatment of post-dural puncture headache after caesarean operations.

BACKGROUND: Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region. GON blockage has been used for the treatment of many kinds of headache. The aim of this retrospective study is to present the results of PDPH treated with GON block over 1 year period in our institute. METHODS: 16 patients who had been diagnosed to have PDPH, and performed GON block after caesarean operations were included in the study. GON blocks were performed as the first treatment directly after diagnose of the PDPH with levobupivacaine and dexamethasone. RESULTS: The mean VAS score of the patients was 8.75 (±0.93) before the block; 3.87 (±1.78) 10min after the block; 1.18 (±2.04) 2h after the block and 2.13 (±1.64) 24h after the block. No adverse effects were observed. CONCLUSIONS: Treatment of PDPH with GON block seems to be a minimal invasive, easy and effective method especially after caesarean operations. A GON block may be considered before the application of a blood patch.