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Kumar A, Sinha C, Singh K, Anant M, Kumar A, Kumari P. Comparative evaluation of nebulised dexmedetomidine vs fentanyl for the treatment of post-dural puncture headache (PDPH) in parturients after caesarean section under spinal anaesthesia: A randomised controlled study. Indian J Anaesth 2024; 68:159-164. [PMID: 38435665 PMCID: PMC10903780 DOI: 10.4103/ija.ija_789_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 03/05/2024] Open
Abstract
Background and Aims The incidence of post-dural puncture headache (PDPH) following spinal anaesthesia in the obstetric population is around 0.5%-2%. Hydration, bed rest, caffeine, paracetamol, non-steroid anti-inflammatory drugs, epidural blood patches, etc., are the various modalities used for its management. This study aims to compare nebulised dexmedetomidine versus fentanyl for the treatment of PDPH in parturients after caesarean section under spinal anaesthesia. Methods Ninety obstetric patients aged 18-35 years with American Society of Anesthesiologists (ASA) physical status II/III and suffering from PDPH as per the criteria of the International Headache Society after caesarean section under spinal anaesthesia were recruited in this double-blinded randomised study. Patients were randomised to Group D (dexmedetomidine 1 µg/kg nebulisation), Group F (fentanyl 1 µg/kg nebulisation), and Group S (saline nebulisation 4mL). The nebulisation was done 12 hourly for 72 hours. Assessment parameters included pain score and the requirement of additional treatment such as paracetamol, caffeine, and epidural blood patch. Analysis of variance test was used for continuous quantitative variables, and the Kruskal-Wallis test was used for quantitative discrete data. Results The pain scores at 1, 6, 12, 24, 48, and 72 hours following nebulisation were significantly lower in Group D in comparison to groups F and S (P < 0.001). The number of patients requiring additional analgesic therapy was lower in Group D in comparison to patients in other groups (P < 0.001). Conclusion Dexmedetomidine nebulisation resulted in effective reduction in PDPH symptoms and pain scores. Nebulisation with fentanyl did not alleviate PDPH symptoms when compared to the control group.
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Affiliation(s)
- Amarjeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Chandni Sinha
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kunal Singh
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Monika Anant
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Poonam Kumari
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, Bihar, India
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Alatni RI, Alsamani R, Alqefari A. Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review. Cureus 2024; 16:e52330. [PMID: 38361721 PMCID: PMC10867709 DOI: 10.7759/cureus.52330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Post-dural puncture headache (PDPH) is occasionally an inevitable side effect of neuraxial anesthesia, which can happen after spinal anesthesia or if an accidental dural puncture (ADP) happens during epidural anesthesia. The treatment and prevention options for PDPH differ widely from one institution to another. The management of PDPH is heterogeneous in many institutions because of the absence of clear guidelines and protocols for the management of PDPH. This study aimed to summarize all articles published during the past decade that discussed the treatment or prevention of PDPH. From 2013 to 2023, 345 publications were filtered for all treatment and prevention approaches used for PDPH patients. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guidelines were followed for conducting this systematic review, and 38 articles were included for analysis and review. Existing data come from small randomized clinical trials and retrospective or prospective cohort studies. This review supports the effect of oral pregabalin and intravenous aminophylline in both treatment and prevention. Intravenous mannitol, intravenous hydrocortisone, triple prophylactic regimen, and neostigmine plus atropine combination showed effective and beneficial outcomes. On the other hand, neither neuraxial morphine nor epidural dexamethasone showed promising results. Consequently, the use of neuraxial morphine or epidural dexamethasone for the prevention of PDPH remains questionable. Regarding the posture of the patient and its consequences on the incidence of the headache, lateral decubitus is better than a sitting position, and a prone position is better than a supine position. Smaller non-cutting needles play a role in avoiding PDPH. Minimally invasive nerve blocks, including sphenopalatine ganglion or greater occipital nerves, are satisfyingly effective. Epidural blood patches remain the more invasive but the gold standard and ultimate solution in patients resisting medical therapy. This study highlights the need for larger research to define the best approach to prevent and treat PDPH.
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Affiliation(s)
| | - Rana Alsamani
- Medicine and Surgery, Qassim University, Qassim, SAU
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Aniceto L, Gonçalves L, Gonçalves L, Alves R, Gonçalves D, Laranjo M, Valente E. Incidence and Severity of Post-dural Puncture Headache in Non-obstetric Patients Undergoing Subarachnoid Block. Cureus 2023; 15:e47442. [PMID: 38022139 PMCID: PMC10659818 DOI: 10.7759/cureus.47442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background and goal of the study Post-dural puncture headache (PDPH) is a complication of central neuraxial block, either subarachnoid block (SAB) or epidural block. This clinical entity has a wide incidence and is affected by factors such as age, gender, needle gauge, needle shape/type, number of puncture attempts, and previous history of headache. Due to the lack of data in the non-obstetric population, this study assesses the incidence and severity of PDPH after SAB. Materials and methods A prospective observational study was carried out on patients undergoing SAB during the last trimester of 2020. Data were recorded on the day of surgery, 48 hours, and seven days after surgery. Data collected included demographic and medical clinic information, SAB procedure details, and clinical outcomes related to the presence of PDPH. Results and discussion Overall, 143 patients were included (median age: 62 years; 53.1% were women (n=76)). Most patients were aged >60 years (55.9%; n=80) and ASA 2 classification (65.0%; n=93). The incidence of PDPH was 21.7% (n=31), and most cases were from inpatient surgery (58.3%, n=21). The incidence of PDPH was 2.5 times higher with the use of 25 gauge compared to the use of the 27 gauge needle and was more prevalent with the use of the Quincke needles. Conclusion Over 20% of patients undergoing SAB experienced PDPH. Previous history of headache, larger gauge, and the Quincke needle use were associated with a higher incidence of PDPH.
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Affiliation(s)
- Leonor Aniceto
- Anesthesiology, Centro Hospitalar de Leiria, Leiria, PRT
| | - Luís Gonçalves
- Anesthesiology, Centro Hospitalar de Leiria, Leiria, PRT
| | | | - Rita Alves
- Anesthesiology, Centro Hospitalar de Leiria, Leiria, PRT
| | | | - Marta Laranjo
- Anesthesiology, Centro Hospitalar de Leiria, Leiria, PRT
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Ivanenko E, Belagaje A, Mahesh S, Vithoulkas G. Homeopathic Manganum in the Management of Post Dural Puncture
Headache, A Case Series. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2022; 15:11795476221135426. [PMCID: PMC9630889 DOI: 10.1177/11795476221135426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
Post-dural puncture headache (PDPH) is a functional condition caused by
disruption of the dural membrane with low cerebrospinal fluid pressure,
affecting 4% to 11% of the patients who undergo procedures where the spinal
canal is purposefully punctured. It has a significant impact on the quality of
life of those affected. We present 12 cases diagnosed with PDPH, unresponsive to
usual treatment, who were treated with classical homeopathy. Nine of the 12
cases showed complete recovery, while the remaining 3 cases showed partial
improvement. The author has stressed on the importance of pathology-based
prescriptions, in his teachings and also the importance of appreciating the
pathology as emphasized in homeopathic literature. The homeopathic remedy
Manganum helped in the improvement of 9 of the 12 cases,
with promising results. Further controlled studies are needed to determine the
role and mechanism of PDPH resolution via homeopathic
Manganum.
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Affiliation(s)
| | | | - Seema Mahesh
- Centre For Classical Homeopathy,
Bengaluru, Karnataka, India,Seema Mahesh, Centre For Classical
Homeopathy, No. 10, 6th Cross, Chandra Layout, Vijayanagar Bengaluru 560040,
India.
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Asmara RY, Sukmono B, Pryambodho P. Successful Treatment of Post-dural Puncture Headache with Sphenopalatine Ganglion Block in Post-cesarean Section Patient: A Case Report. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Post-dural puncture headache is a symptom often found in post-operative patients who receive spinal anesthesia. Therefore, therapy to reduce patient complaints becomes a comparison to find the best alternative for action. This case discusses post-dural puncture headache risk factors in post-cesarean section patients and sphenopalatine ganglion block as an alternative pain intervention.
CASE PRESENTATION: The patient is a 26-year-old woman, G1P0A0, 80 kg, who presented for the first cesarean delivery at 37 weeks of gestational age due to concern for breech presentation. The patient was put into a sitting posture before the spinal anesthetic was administered. She was offered spinal-epidural anesthesia using a Quincke type 26 G spinal needle. The patient was successfully given one shot of spinal anesthesia using the paramedian approach technique. The medication of 1 g paracetamol was given at 8 h intervals as post-operative analgesia. On post-operative day 2, the patient was consulted by the anesthesiologist, and the patient reported an 8/10 severity positional headache on the numerical rating scale. Intranasal SPGB has been performed on the patient with lidocaine spray 20 mg. The patient’s headache reduced from an NRS of 8/10 to a 6/10 after 5 min of sphenopalatine ganglion block. Twenty-four hours after the procedure, the patient can sit up, lower the neck tension and headache, and resume activities independently. The patient was released the next day with a manageable headache. In 48 h post-block, the patient was called and inquired about PDPH and almost no headache with various positions.
CONCLUSION: SPG block can be a minimally invasive treatment for PDPH. The faster PDPH is treated using an SPG block, the better the patient’s pain scale outcome. Several studies have shown that patients who received SPG block therapy did not continue to get EBP.
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Shaat AM, Abdalgaleil MM. Is theophylline more effective than sumatriptan in the treatment of post-dural puncture headache? A randomized clinical trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1949195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Benhardt AC, Kodali BS. All epidural needle bevels are not the same. Indian J Anaesth 2021; 65:328-330. [PMID: 34103748 PMCID: PMC8174589 DOI: 10.4103/ija.ija_1503_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 12/04/2022] Open
Affiliation(s)
- Amber C Benhardt
- Department of Anesthesiology, Washington School of Medicine, 660 South Euclid Ave, St Louis, Missouri, United States
| | - Bhavani Shankar Kodali
- Department of Anesthesiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, Maryland, United States
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Ali WA, Mohammed M, Abdelraheim AR. Effect of intrathecal fentanyl on the incidence, severity, and duration of postdural puncture headache in parturients undergoing caesarean section: A randomised controlled trial. Indian J Anaesth 2020; 64:965-970. [PMID: 33487682 PMCID: PMC7815015 DOI: 10.4103/ija.ija_49_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/11/2020] [Accepted: 06/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background and Aims: Postdural puncture headache (PDPH) is a side effect of spinal anaesthesia (SA). This study was conducted to investigate the effect of intrathecal fentanyl on the incidence, severity, and duration of PDPH. Methods: This was a prospective randomised controlled study including 220 parturients, who underwent Caesarean section (CS). They were divided into two groups for administration of SA with bupivacaine (bupivacaine group [B0], n = 111) or bupivacaine with fentanyl (bupivacaine fentanyl group [BF], n = 109). Haemodynamics, quality of anaesthesia, maternal side effects, and postoperative analgesia were noted. The neonatal Apgar score was recorded. The patients were followed up for 14 days after CS for the occurrence of PDPH, and its severity and duration. The collected data were statistically analysed, using the Statistical Package for the Social Sciences software version 25. Results: Regarding haemodynamics, heart rate increased at 5 min post-induction and blood pressure decreased at 2min post-induction in both groups. Excellent intraoperative anaesthesia was obtained in 91.7% and 79.3% of cases in groups BF and B0, respectively (P < 0.01). Longer duration of postoperative analgesia was present in the BF group as compared to the B0 group (P < 0.001). The incidence of PDPH decreased in the BF group in a non-significant manner, whereas its severity and duration increased significantly in the B0 group. Conclusion: Although the addition of intrathecal fentanyl to bupivacaine for SA in CS patients did not reduce the incidence of PDPH significantly, its severity and duration decreased significantly.
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Affiliation(s)
- Wegdan A Ali
- Department of Anaesthesia and Intensive, Minia University, Minia, Egypt
| | - Mo'men Mohammed
- Department of Obstetrics and Gynaecology, Minia University, Minia, Egypt
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Zandi S, Atcheson CLH, Yousefi SR, Zahedi F, Mirkarimi S, Nasseri K. Postpartum Headache due to Cerebellar Infarct Initially Misdiagnosed as Postdural Puncture Headache: A Case Report. A A Pract 2020; 14:e01190. [PMID: 32224699 DOI: 10.1213/xaa.0000000000001190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We present the case of a 39-year-old woman with postpartum cerebellar infarction (CI) following spinal anesthesia for cesarean delivery. The patient experienced mild headache after postoperative day 1 and returned on postoperative day 6 with a severe headache. For the subsequent 3 days, she underwent conservative treatment for presumed postdural puncture headache (PDPH) before neurologic decline and diagnosis of CI on postoperative day 9. She subsequently underwent craniotomy and debridement of necrotic tissues. Prolonged or position-independent postpartum headache should prompt broadening of the differential diagnosis beyond PDPH to include other more rare but serious causes of postpartum headache.
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Affiliation(s)
- Shokrollah Zandi
- From the Department of Neurosurgery, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | | | - Seyedeh Reyhaneh Yousefi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farhad Zahedi
- Department of Anesthesiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sadafsadat Mirkarimi
- Department of Anesthesiology, Jacobi Medical Center, Albert Einstein College of Medicine, PGY1 Preliminary Resident, New York, New York
| | - Karim Nasseri
- Department of Anesthesiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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