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6 results

  • Chapter 11 - Post-dural Puncture Headache

  • from Part III - Chronic Pain Conditions Head and Neck
  • Edited by Omar Viswanath, Creighton University, Omaha, Ivan Urits, Southcoast Brain & Spine Center, Wareham
  • Book:
    Cambridge Handbook of Pain Medicine
    Published online:
    01 December 2023
    Print publication:
    14 December 2023, pp 69-74

  • Summary

    Common adverse complication following dural puncture (DP) during epidural orspinal anesthesia which results in symptoms such as dull throbbing headache, fronto-occipital distribution, worse in seated position, alleviated when supine. Other symptoms include nausea, vomiting, neck stiffness, and tinnitus. Adverse event is seen commonly in patients receiving epidural or spinal neuraxial anesthesia, which occurs following inadvertent puncture of the dura. Conservative treatment is often adequate in majority of the patients, but medical management can be used liberally with a variety of safe, well-studied pharmacologic options. Epidural blood patch is the gold standard in treating unremitting PDPH but should be used cautiously due to the potential for rare but serious complications.

  • Chapter 17 - Fasting and aspiration prophylaxis in labor and for cesarean section

  • Edited by Ian McConachie, University of Western Ontario
  • Book:
    Controversies in Obstetric Anesthesia and Analgesia
    Published online:
    05 December 2011
    Print publication:
    17 November 2011, pp 207-214

  • Summary

    The prevention and management of postdural puncture headache (PDPH) in the obstetric patient continues to challenge the anesthesiologist. This chapter discusses the clinical management of PDPH in obstetric patients and suggests recommendations based on current, relevant evidence. The presence of focal neurological signs may point toward other neurological problems and prompt further investigations and assessments. The low cerebrospinal fluid (CSF) volume causes a drop in subarachnoid pressure. The incidence of PDPH in obstetric patients is relatively high due to the effects of gender and young adult age. It is also related to the size and design of the needle used and the experience of the anesthesiologist carrying out the procedure. Larger randomized controlled trials may help provide insight into the optimal use of the epidural blood patch (EBP) and other treatments. Such trials will be difficult to perform due to the low incidence of accidental dural puncture (ADP) and PDPH.