Huili Li1, Yun Wang1, Adriana D Oprea2, Jinlei Li3. 1. Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China. 2. Department of Anesthesiology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA. 3. Department of Anesthesiology, Yale University School of Medicine, 20 York Street, New Haven, CT, 06510, USA. jinlei.li@yale.edu.
Abstract
PURPOSE OF REVIEW: This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH). RECENT FINDINGS: PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
PURPOSE OF REVIEW: This manuscript aims to review the risks and the current treatments for postdural puncture headache (PDPH). RECENT FINDINGS: PDPH is a relatively frequent complication after neuraxial blocks. It is typically orthostatic in nature, presenting as a positional and dull aching or throbbing headache, with added dysregulation of auditory and/or visual signals. Certain characteristics, such as female sex and young age, may predispose patients to the development of PDPH, as may factors such as previous PDPH, bearing down during the second stage of labor, and the neuraxial technique itself. Long-term complications including chronic headache for years following dural puncture have brought into question of the historical classification of PDPH as a self-limiting headache. So far, the underlying mechanism governing PDPH remains under investigation, while a wide variety of prophylactic and therapeutic measures have been explored with various degree of success. In case of mild PDPH, conservative management involving bed rest and pharmacological management should be used as first-line treatment. Nerve blocks are highly efficient alternatives for PDPH patients who do not respond well to conservative treatment. In case of moderate-to-severe PDPH, epidural blood patch remains the therapy of choice. An interdisciplinary approach to care for patients with PDPH is recommended to achieve optimal outcomes.
Authors: Christopher R Abrecht; Ramsey Saba; Penny Greenberg; James P Rathmell; Richard D Urman Journal: Anesth Analg Date: 2019-07 Impact factor: 5.108