What is a PDPH?
Postdural puncture headache (PDPH) is a potential expected complication of a lumbar puncture, with symptoms related to traction on pain-sensitive structures from low cerebrospinal fluid (CSF) pressure (intracranial hypotension) following a leak of CSF at the puncture site.
What causes PDPH?
PDPH is thought to result from a loss of cerebrospinal fluid into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms.
Is PDPH life threatening?
Although not life-threatening, PDPH carries substantial morbidity by restricting activities of daily life. Current noninvasive treatments, including bed rest, fluids, analgesics, caffeine, and sumatriptan, only temporize the discomfort .
How do you reduce PDPH?
Insertion of cutting needles parallel to the long axis of the spine is an effective method of reducing the incidence of PDPH and is easily effected in clinical practice. The role of stylet reinsertion when using cutting needles has yet to be fully elucidated.
How common is epidural puncture?
Young patients and women having the spinal or epidural for childbirth are more likely than other people to have a postdural puncture headache. How likely is it? The risk of getting a post dural puncture headache after an epidural or spinal injection is between 1 in 100 and 1 in 500 procedures.
Are blood patches successful?
Success rates for blood patches are 90% for the first blood patch, and 95% for the second blood patch. Blood patches are performed for treatment of a persistent headache (spinal headache) and nausea that sometimes follows a spinal puncture. These symptoms do not occur frequently.
How common is dural puncture?
The incidence of accidental dural puncture varies on the experience of the provider and is approximately 1.5%. When experts in regional anesthesia were asked regarding the incidence of post dural puncture headache (PDPH), the response was 1% for epidural anesthesia and 1% for spinal anesthesia.
What is wet tap epidural?
During epidural anesthesia, a needle is advanced to the epidural space which is just in front of the dura. Rarely, the needle punctures the dura causing a leak of spinal fluid. This is known as a dural puncture, often called a wet tap. A wet tap can result in the development of a headache.
What is a wet tap epidural?
What are the risks of a blood patch?
Complications. Commonly reported side effects and/or complications include transient paresthesias, transient radicular lower-extremity pain, local back pain, and/or pressure at the site of the injection (which may last up to 2 days), dizziness, vertigo, tinnitus, and rebound intracranial hypertension.
When does cerebrospinal fluid puncture cause PDPH?
It is a common side-effect of spinal anesthesia and lumbar puncture. Leakage of cerebrospinal fluid puncture causes reduced fluid levels in the brain and spinal cord. Onset occurs within two days in 66 percent and within three days in ninety percent of PDPH cases.
What is the practical significance of PDPH in pain management?
The practical significance of PDPH is illustrated by notation in the American Society of Anesthesiologists Closed Claims Project database as one of the most frequent claims for malpractice involving obstetric anesthesia, regional anesthesia, and chronic pain management.
What’s the average duration of untreated PDPH headaches?
He concluded by noting that 3 days was the usual duration of untreated mild-to-moderate headaches, but that, “Nevertheless, the patient feels an attempt to help his problem is being made.” The EBP, a startlingly unique medical procedure, proved to be the major breakthrough in the treatment of PDPH.
Is the PDPH the same as the subarachnoid space?
Regardless of terminology, the PDPH is well known to the many clinicians whose practice includes procedures that access the subarachnoid space. Yet, our understanding of this serious complication remains surprisingly incomplete.