Riki Patel1, Ivan Urits2, Vwaire Orhurhu3, Mariam Salisu Orhurhu4, Jacquelin Peck5, Emmanuel Ohuabunwa6, Andrew Sikorski1, Armeen Mehrabani1, Laxmaiah Manchikanti7, Alan D Kaye8, Rachel J Kaye8, John A Helmstetter8, Omar Viswanath9,10,11. 1. Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA. 2. Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. iurits@bidmc.harvard.edu. 3. Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. 4. Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA. 5. Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA. 6. Department of Emergency Medicine, Yale New Haven Health System, New Haven, CT, USA. 7. Pain Management Centers of America, Paducah, KY, USA. 8. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA. 9. Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA. 10. Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA. 11. Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.
Abstract
PURPOSE OF REVIEW: The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis. RECENT FINDINGS: 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%. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. 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. For mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment; however, this invasive treatment is not without inherent risks. Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap; all have shown promise. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. There is still limited evidence in literature about the understanding of PDPH and optimal treatment.
PURPOSE OF REVIEW: The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis. RECENT FINDINGS: 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%. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. 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. For mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment; however, this invasive treatment is not without inherent risks. Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap; all have shown promise. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. There is still limited evidence in literature about the understanding of PDPH and optimal treatment.
Authors: Heather S Dodge; Nosakhare N Ekhator; Lena Jefferson-Wilson; Mark Fischer; Ian Jansen; Paul S Horn; William E Hurford; Thomas D Geracioti Journal: Pain Physician Date: 2013-01 Impact factor: 4.965
Authors: Stephanie A Neuman; Jason S Eldrige; Wenchun Qu; Eric D Freeman; Bryan C Hoelzer Journal: Pain Physician Date: 2013 Mar-Apr Impact factor: 4.965