Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

A Hospital-Based Quality Improvement Initiative to Reduce Postdural Puncture Headache in Cesarean Deliveries

BACKGROUND

 Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia in cesarean deliveries. This study aimed to reduce PDPH incidence through a quality improvement initiative focusing on operating room (OR) efficiency and anesthetic management.

METHODS

 Using Plan-Do-Study-Act (PDSA) cycles, interventions included preoperative catheterization, synchronized scrubbing, and improved surgeon-anesthetist coordination. Spinal anesthesia protocols were refined with atraumatic needle techniques and standardized vasopressor use. Data from the pre-intervention (April to October 2023) and post-intervention (November 2023 to April 2024) periods were compared.

RESULTS

 OR time decreased from 105 to 85 minutes. PDPH incidence dropped from 16% (21/140 lower segment cesarean sections (LSCS)) to 1.5% (2/127 LSCS). Vasopressor use declined, with ephedrine doses reducing from 17 mg to 6 mg and phenylephrine from 30 mcg to 5 mcg, improving hemodynamic stability.

CONCLUSION

 Workflow enhancements effectively reduced PDPH incidence by optimizing OR efficiency and anesthetic management. Iterative PDSA cycles and real-time feedback contributed to sustained improvements, offering a scalable model for cesarean delivery quality improvement.

Efficacy of therapies for post dural puncture headache

PURPOSE OF REVIEW

Clinical management of postdural puncture headache (PDPH) remains an interdisciplinary challenge with significant impact on both morbidity and quality of life. This review aims to give an overview of the most recent literature on prophylactic and therapeutic measures and to discuss novel findings with regard to currently published consensus practice guideline recommendations.

RECENT FINDINGS

Although current evidence does not support a recommendation of any specific prophylactic measure, new data is available on the use of intrathecal catheters to prevent PDPH and/or to avoid invasive procedures. In case of disabling or refractory symptoms despite conservative treatments, the epidural blood patch (EBP) remains the therapeutic gold standard and its use should not be delayed in the absence of contraindications. However, recent clinical studies and meta-analyses provide additional findings on the therapeutic use of local anesthetics as potential noninvasive alternatives for early symptom control.

SUMMARY

There is continuing research focusing on both prophylactic and therapeutic measures offering promising data on potential alternatives to invasive procedures, although there is currently no treatment option that comes close to the effectiveness of an EBP. A better understanding of PDPH pathophysiology is not only necessary to identify new therapeutic targets, but also to recognize patients who benefit most from current treatments, as this might enhance their therapeutic efficacy.