Post-dural puncture headache in the parturient

Publication date: Available online 25 June 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Dipali Verma, Cathy Armstrong Post-dural puncture headache (PDPH) is one of the most common and debilitating complications of central neuraxial blockade in the parturient. The obstetric population is at particular risk with up to 80% of women developing symptoms after accidental dural puncture during labour epidural insertion. PDPH typically develops 24–48 hours post puncture and is classically described as an occipito-frontal headache with postural features. Diagnosis and assessment should include consideration of other potential causes of postpartum headache. At the time of accidental dural puncture, insertion of an intrathecal catheter does not reduce the incidence of headache though a reduction in blood patch requirement is still debated. Initial treatment of a PDPH includes bed rest, adequate hydration and simple analgesics. Other drugs including caffeine, gabapentin, theophylline and hydrocortisone may reduce pain scores; however, evidence is lacking in quality and quantity. Epidural blood patch (EBP) remains the gold standard treatment of PDPH. It is more successful if performed over 24–48 hours after the development of symptoms with approximately 45–65% of symptoms cured after the first attempt and 90–95% after the second.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research