The management of a postdural puncture headache in a child

Management of Post-Dural Puncture Headaches in Pediatric Patients with Epidural Blood or Saline Patch: An Educational Focused Review

Post-dural puncture headache (PDPH) is a common adverse outcome following puncture of the dura. It can occur after inadvertent dural puncture during epidural catheter placement or following diagnostic or therapeutic LP. The incidence of PDPH in pediatric patients has been estimated at 1-15% depending on patient factors (age, gender, body mass index) and needle factors (size and needle bevel/point type). The larger the needle gauge, the higher the incidence of PDPH. Various options have been proposed to treat PDPH including observation, bed rest, hydration, caffeine, and epidural blood/saline patch. The current manuscript provides a review of the use of epidural blood/saline patch in pediatric-aged patients with PDPH.

Evidence-Based Practice Recommendations to Prevent/Manage Post-Lumbar Puncture Headaches in Pediatric Patients Receiving Intrathecal Chemotherapy

Post-lumbar puncture headaches (PLPHs) are a known complication of lumbar puncture procedures. Children undergoing treatment for cancer often undergo multiple lumbar punctures, placing them at increased risk for PLPHs. There are currently no guidelines for the prevention or management of PLPHs in children. A team was therefore assembled to conduct a systematic review of the evidence in relationship to PLPHs in the pediatric population. Clinical questions were developed and used to guide the literature review. Twenty-four articles were deemed appropriate for use and were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Based on the review of evidence, strong recommendations are made for the use of smaller needle sizes and for the use of pencil point needles during lumbar puncture procedures. Weak recommendations are made for needle orientation and positioning following the procedure as well as for interventions used to treat PLPHs once they occur. There is a need for additional, pediatric-specific studies to further examine the issue of PLPH prevention and treatment.

Recent developments in paediatric regional anaesthesia

PURPOSE OF REVIEW

This review will focus on recently published data concerning side effects and complications of paediatric regional anaesthesia, putting into perspective the currently used techniques.

RECENT FINDINGS

Penile block is clearly a technique with a very large benefit and minimal side effects. Ilioinguinal nerve block, on the other hand, quite commonly leads to complications. Single-shot caudal anaesthesia is considered a safe and effective technique; however, even with this widely used block, complications such as sacral osteomyelitis can occur. Recent review articles have focussed on the role of additives for prolonging the duration of paediatric caudal anaesthesia. The use of ketamine or s-ketamine as an additive appears to be most promising for the future.

SUMMARY

Paediatric regional anaesthesia is now widely used for postoperative pain relief in children. However, a careful risk-benefit analysis is always mandatory before such medical interventions are undertaken.