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Post-dural-puncture headache (PDPH) is a complication of puncture of the dura mater (one of the membranes around the brain and spinal cord). [3] The headache is severe and described as "searing and spreading like hot metal", involving the back and front of the head and spreading to the neck and shoulders, sometimes involving neck stiffness.
Post dural puncture headache (PDPH) is a side of effect of spinal anesthesia, where the clinician accidentally punctures the dura with the spinal needle and causes leakage of CSF. Factors such as pregnancy, having a low body mass index, being a female and young, increase the risk of dural puncture.
The injected blood clots at the site of the puncture, closes the leak, and modulates CSF pressure. [18] [19] This may be used to treat post-dural-puncture headache and leakage of cerebrospinal fluid due to dural puncture, which occurs in approximately 1.5% of epidural analgesia procedures. [20]
Post-dural-puncture headache or post-spinal headache [4] – Associated with the size and type of spinal needle used. A 2020 meta analysis recommended use of the 26G atraumatic spinal needle to lower the risk of PDPH – specifically, the Braun Atraucan 26G needle. [10]
Combined spinal and epidural anaesthesia in labouring women is associated with more pruritus if fentanyl (25 μg) is given intrathecally, than low-dose epidural analgesia. However, no difference has been found in the incidence of post dural puncture headache, requirement for epidural blood patch or maternal hypotension. [2]
But following accidental dural puncture, headache occurs in up to 85% of patients causing significant perioperative morbidity. [1] However, in case of inadvertent dural perforation, the incidence of headache can be lowered by identifying the epidural space with the needle bevel oriented parallel to the longitudinal dural fibers which limits the ...
Sometimes, lumbar puncture cannot be performed safely (for example due to a severe bleeding tendency). It is regarded as a safe procedure, but post-dural-puncture headache is a common side effect if a small atraumatic needle is not used. [1] The procedure is typically performed under local anesthesia using a sterile technique.
Sphenopalatine ganglion block has been used to treat post-dural-puncture headache, [2] though a 2020 trial comparing local anaesthetic sphenopalatine ganglion block to sham injection with saline failed to show difference in pain scores for those receiving local anaesthetic vs placebo, suggesting any efficacy is unrelated to local anaesthetic ...