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Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Epidural blood patch is considered the definitive treatment for post-dural puncture headache. The technique involves the injection of 10 to 20mL of autologous blood in the epidural space near the original epidural puncture site. Its effectiveness has been reported to be as high as 97% (109). A long-term follow-up study of nonobstetric patients, however, showed that only 61% of patients had a permanent resolution of headache despite an initial success rate of 88% to 96% (110). More recently, a study in an obstetric population showed that only 15% required a repeat blood patch (111). Epidural blood patch has a long history of effectiveness and safety. Nevertheless, if a patient should require more than two blood patches, a search for another cause of headache should be made.
Disorders of the nervous system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
A post-dural-puncture headache can occur following an accidental dural puncture during the insertion of an epidural. The pain is related to posture, occurring or worsening when becoming upright. The woman will be cared for lying flat, and if the headache persists, it is usually treated with a blood patch (Thew and Paech, 2008).
Regional anaesthesia
Published in Daniel Cottle, Shondipon Laha, Peter Nightingale, Anaesthetics for Junior Doctors and Allied Professionals, 2018
It is important to be aware of these when consenting your patient as they are numerous, some common and some very rare. A recent national audit by the Royal College of Anaesthetists attempted to quantify the risk of certainly the more serious complications and it may be useful to read at least the summary so you can allow your patients to make an informed choice.3Immediate: › bloody tap› dural tap – leading to post-dural puncture headache› total spinal› high block› intravenous injection› hypotension – rarely leading to anterior spinal artery syndrome› nausea and vomiting› direct nerve trauma.Delayed: › urinary retention› infection or abscess› haematoma› arachnoiditis.
Safety of treatment options available for postoperative pain
Published in Expert Opinion on Drug Safety, 2021
Zhaosheng Jin, Christopher Lee, Kalissa Zhang, Tong J Gan, Sergio D Bergese
Epidural analgesia is one of the first regional anesthesia techniques conceived, and involves the delivery of local anesthetics to the epidural space, which targets the nerve roots as they exit the spinal dura sheath. One of the main concerns of epidural analgesia is the risk of unintentional dura puncture, which can lead to post-dural puncture headache; other risks include epidural hematoma and epidural abscess. Our institution previously published a ten-year cross-sectional study based on the obstetric population, which reported that the risk of post-dural puncture headache risk with labor epidural was 0.9% [72]. Katircioglu et al. reported 35,628 cases of epidural analgesia in patients undergoing gynecological procedures as well as labor and delivery, they reported 0.1% incidence of overt cerebral spinal fluids leak, as well as 0.01% risk of seizure and neurogenic bladder [73].
Is theophylline more effective than sumatriptan in the treatment of post-dural puncture headache? A randomized clinical trial
Published in Egyptian Journal of Anaesthesia, 2021
Ahmed Mohamed Shaat, Mohamed Mahmoud Abdalgaleil
Post-dural puncture headache (PDPH) is a frequent complication of spinal anaesthesia or dural puncture and is an uncomfortable situation for both the patient and the anaesthetist. It is attributed to decreased cerebrospinal fluid (CSF) pressure leading to meningeal traction and cerebral vasodilation. [1] It is an orthostatic headache occurring within 5 days of a dural puncture, 66% starts within the first 48 hours, and about 90% within the first 72 hours. It is usually accompanied by neck pain, tinnitus, hearing changes, photophobia, and/or nausea and relieved spontaneously within 2 weeks, after normalization of CSF pressure, rarely may last for up to 6 weeks. [2] Risk factors include: young age, female sex, pregnancy, large needle size, the direction of the cutting needle bevel when puncturing the dura, multiple dural punctures, and previous history of PDPH. [3]
Spinal cord stimulation for the treatment of neuropathic pain: expert opinion and 5-year outlook
Published in Expert Review of Medical Devices, 2020
Mark N. Malinowski, Sameer Jain, Navdeep Jassal, Timothy Deer
The two broad complications classes associated with spinal cord stimulation are biological and hardware-related complications. Biological complications can be further segregated into neurological, infectious, hematological, and habituation/tolerance. Hardware-related complications include hardware-related pain, lead migration, and painful stimulation. Neurological complications may range from mild to devastating. Neurological complications include dural puncture and post-dural puncture headache, traumatic nerve and/or spinal cord injury and paralysis. Hematological and infectious complications share similar disastrous effects, at least in the early stages. Compression of the spinal cord from mass effect of a hematoma or abscess may will likely lead to cord and/or nerve root ischemia. Infectious causes present with similar symptoms, but presentation will also be supported by clinical evidence for infection such as constitutional symptoms and meningeal symptoms, and blood work changes such as elevated erythrocyte sedimentation rate, inflammatory markers (e.g., C-reactive protein) and elevated white blood cell count.