![]() Effect of position during spinal anesthesia on postdural puncture headache after cesarean section: a prospective, single-blind randomized clinical trial. Effectiveness of lateral decubitus position for preventing post-dural puncture headache: a meta-analysis. This is a great paper that compares pencil-point spinal needle in spinal anesthesia related to postdural puncture headache. Comparison of cutting and pencil-point spinal needle in spinal anesthesia regarding postdural puncture headache: a meta-analysis. Xu H, Liu Y, Song W, Kan S, Liu F, Zhang D, et al.This is a great paper that discusses needle gauge and tip designs to prevent post dural puncture headache. Needle gauge and tip designs for preventing post-dural puncture headache (PDPH). Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, Ciapponi A, Arevalo JJ, Boogaard S, et al.Ten years of experience with accidental dural puncture and post-dural puncture headache in a tertiary obstetric anaesthesia department. Van de Velde M, Schepers R, Berends N, Vandermeersch E, De Buck F. ![]() This is a great review and meta-analysis discussing lumbar puncture needles. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. Nath S, Koziarz A, Badhiwala JH, Alhazzani W, Jaeschke R, Sharma S, et al.Neuraxial labor analgesia: a focused narrative review of the 2017 literature. Kocarev M, Khalid F, Khatoon F, Fernando R. Review of the alternatives to epidural blood patch for treatment of postdural puncture headache in the parturient. Experiments on the spinal cord cocainization. Papers of particular interest, published recently, have been highlighted as: There is still limited evidence in literature about the understanding of PDPH and optimal treatment. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. ![]() Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap all have shown promise. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment however, this invasive treatment is not without inherent risks. ![]() Summaryįor mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. Various prophylactic measures have been studied however, more studies have been recommended to be undertaken in order to establish a proven benefit. PDPH is a self-limiting postural headache that most often will resolve within 1 week, without need for treatment. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. The overall incidence of PDPH after neuraxial procedures varies from 6 to 36%. PDPH is an adverse iatrogenic complication of neuraxial anesthesia that occurs following inadvertent puncture of the dura after epidural or spinal anesthesia. The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis. ![]()
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