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Sheffield Kent, Gregory Mehaffey
STUDY OBJECTIVE: To demonstrate a possible alternative treatment for postdural puncture headache (PDPH). DESIGN: Postdural puncture headache is a common complication associated with neuraxial anesthesia and unintentional dural puncture. Epidural blood patch (EBP) is the standard therapy for PDPH but has risks including pain, dural puncture, and infection. Transnasal sphenopalatine ganglion block (SPGB) has been successfully used to treat migraine, cluster headache, and trigeminal neuralgia...
November 2016: Journal of Clinical Anesthesia
Xiangming Che, Wenyu Zhang, Mingjun Xu
STUDY OBJECTIVE: Postdural puncture headache (PDPH) is the most common symptom of accidental dural puncture, a frequent complication of intraspinal anesthesia. We developed a postoperative intervention technique to prevent and treat PDPH in accidental dural puncture patients, including epidural pumping of saline. This retrospective study aimed to retrospectively evaluate this new technique for PDPH prevention and treatment. DESIGN: Retrospective study. SETTING: Beijing Obstetrics and Gynecology Hospital affiliated to the Capital Medical University, between January 2006 and December 2012...
November 2016: Journal of Clinical Anesthesia
Antonia Mezzacappa, Negre Isabelle, Cecile Jean-Baptiste, Odile Cazas, Patrick Hardy, Dan Benhamou, Florence Gressier
No abstract text is available yet for this article.
September 2016: Pain Physician
Markus A Bendel, Susan M Moeschler, Wenchun Qu, Eugerie Hanley, Stephanie A Neuman, Jason S Eldrige, Bryan C Hoelzer
A recent publication reported the incidence of postdural puncture headache (PDPH) in conjunction with intrathecal drug delivery system (IDDS) implantation to be nearly 23 percent. Many patients responded to conservative measures but a percentage needed invasive treatment with an epidural blood patch (EBP). There is limited data to describe the technical details, success rates, and complications associated with EBP in this population. This study aims to provide a retrospective report of EBP for patients suffering from PDPH related to IDDS implantation...
2016: Pain Research and Treatment
Esra Uyar Türkyilmaz, Nuray Camgöz Eryilmaz, Nihan Aydin Güzey, Özlem Moraloğlu
BACKGROUND: Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region...
September 2016: Brazilian Journal of Anesthesiology
Sharon Orbach-Zinger, Eran Ashwal, Lilach Hazan, Danielle Bracco, Alex Ioscovich, Liran Hiersch, Andrey Khinchuck, Amir Aviram, Leonid A Eidelman
BACKGROUND: Unintended dural puncture (UDP) is one of the main risks of epidural analgesia, with a reported incidence of approximately 1.5% among the obstetric population. UDP is associated with maternal adverse outcomes, with the most frequent adverse outcome being postdural puncture headache (PDPH). Our retrospective cohort study objective was to identify demographic and obstetric risk factors that increase the risk of unintentional dural puncture as well as describing the obstetric outcome once a dural puncture has occurred...
October 2016: Anesthesia and Analgesia
Hwiwon Lee, Beom-Ju Hong, Jeong Ho Lee, Sujin Yeo, Hoe-Yune Jung, Junho Chung, G-One Ahn, Sei Kwang Hahn
The liver is the most frequent site of metastasis with a 5-year survival rate of only 20-40%. In this work, hyaluronate (HA)-death receptor 5 antibody (DR5 Ab) conjugate was synthesized as a dual targeting therapeutic agent to treat liver metastasis. Dual targeting was achieved by DR5 Ab, a humanized agonistic monoclonal antibody binding to DR5 frequently overexpressed in many kinds of cancer cells, and by HA, a natural polysaccharide binding to HA receptors highly expressed in both the liver and cancer cells...
September 12, 2016: Biomacromolecules
Andres Zorrilla-Vaca, Ryan Healy, Carolina Zorrilla-Vaca
PURPOSE: Post-dural puncture headache (PDPH) is a well-known neurological outcome caused by leakage of cerebrospinal fluid during neuraxial anesthesia. Studies aimed at assessing the efficacy of finer gauged spinal needles to reduce the incidence of PDPH have produced conflicting results. We have therefore examined the effect of the gauge of cutting needles and pencil-point needles, separately, on the incidence of PDPH. METHODS: The PubMed, EMBASE and Google Scholar databases were searched for randomized studies which compared PDPH incidence in a head-to-head analysis of individual needle gauges of similar needle designs (cutting and pencil-point)...
October 2016: Journal of Anesthesia
Khalid M Morsy, Ayman M Osman, Omar M Shaaban, Dina H El-Hammady
BACKGROUND: Patients of chronic pain syndromes like fibromyalgia (FMS) when subjected to spinal anesthesia are theoretically more liable to post dural puncture headache (PDPH) as they have enhanced central nervous system sensitization and decreased descending inhibition. OBJECTIVE: The current study aims to verify the incidence and chronicity of PDPH in FMS patients. STUDY DESIGN: Case control study. METHODS: In a comparative control study, 70 fibromyalgia patients were scheduled for an elective cesarean delivery fibromyalgia group or Group 1...
July 2016: Pain Physician
Esra Uyar Türkyilmaz, Nuray Camgöz Eryilmaz, Nihan Aydin Güzey, Özlem Moraloğlu
BACKGROUND: Post-dural puncture headache (PDPH) is an important complication of neuroaxial anesthesia and more frequently noted in pregnant women. The pain is described as severe, disturbing and its location is usually fronto-occipital. The conservative treatment of PDPH consists of bed rest, fluid theraphy, analgesics and caffeine. Epidural blood patch is gold standard theraphy but it is an invasive method. The greater occipital nerve (GON) is formed of sensory fibers that originate in the C2 and C3 segments of the spinal cord and it is the main sensory nerve of the occipital region...
September 2016: Revista Brasileira de Anestesiologia
Chuanjie Wu, Yajun Lian, Dongsheng Guan, Lijun Wang, Yanyong Miao, Nanchang Xie, Yuan Chen, Yake Zheng
BACKGROUND: Post-dural puncture headache (PDPH) is the most common complication of lumbar puncture. Aminophylline has been reported to be effective in the prevention of PDPH in some clinical studies, but its efficacy for the treatment of PDPH has been unproven. OBJECTIVE: To evaluate the efficacy and safety of an intravenous (IV) injection of aminophylline on PDPH. STUDY DESIGN: The study was a multicenter, open-label study to assess the effectiveness and safety of aminophylline on PDPH...
July 2016: Pain Physician
Michael Heesen, Markus Klimek
Neuraxial labor analgesia can be initiated via combined spinal-epidural (CSE) or stand-alone epidural. Pros and cons of these techniques are outlined in this review. In recent years computer-integrated patient-controlled epidural analgesia (CI-PCEA) and programed intermittent epidural boluses (PIEB) have been developed, adding to continuous infusion and PCEA for the maintenance of neuraxial analgesia. Postdural puncture headache (PDPH) and fever can occur secondary to labor epidural that both have clinical relevance for the care givers...
July 7, 2016: Journal of Perinatal Medicine
Maged Guirguis, Eduardo Jusino, Reda Tolba, Samuel Samuel
Postdural puncture headache (PDPH) is a feared complication related to epidural steroid injections. We report a unique case in which all subjective and objective findings indicated the diagnosis of PDPH. However, the patient failed appropriate conservative and interventional management. Therapeutic failure prompted further investigation to establish the correct diagnosis of cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare, difficult to diagnose, but potentially lethal disorder with nonspecific and variable clinical presentations, including headache and focal neurological deficits...
August 1, 2016: A & A Case Reports
Khaja Mohideen Sherfudeen, Gurumoorthi Ramasamy, Senthil Kumar Kaliannan, Pavan Kumar Dammalapati
Cerebral venous thrombosis (CVT) is a rare complication of lumbar puncture. Occasionally, the clinical picture of CVT may mimic post-dural puncture headache (PDPH) resulting in delayed diagnosis. A case of PDPH progressing to CVT is presented and the pathophysiology, diagnostic challenges and management options discussed in this article.
May 2016: Indian Journal of Anaesthesia
Thomas T Simopoulos, Sanjiv Sharma, Musa Aner, Jatinder S Gill
BACKGROUND: Spinal cord stimulation (SCS) is rapidly expanding therapy for the treatment of refractory neuropathic pain. Although technical issues such as battery life and lead migration have been well studied and improved, little is known about the incidence and management of inadvertent dural puncture and consequent headache. OBJECTIVES: The goals of this article were to determine the incidence of postdural puncture headache (PDPH) per lead insertion at the various regions of the spine and to detail the use of conservative management and epidural blood patch (EBP)...
May 12, 2016: Neuromodulation: Journal of the International Neuromodulation Society
Mehrdad Masoudifar, Omid Aghadavoudi, Sajjad Adib
BACKGROUND: Postdural puncture headache (PDPH) is a relatively common complication after regional anesthesia, especially in younger people, bothersome to patients and needs prophylaxis to prevent this complication. This study was conducted aiming to determine the preventive effect of dexamethasone plus caffeine and acetaminophen on relative frequency and intensity of PDPH after spinal anesthesia. MATERIALS AND METHODS: In a clinical trial study, 90 candidates for the lower extremities orthopedic elective operation were divided into two groups of 45 individuals each...
2016: Advanced Biomedical Research
Steven R Hanling, Joseph E Lagrew, Derrick H Colmenar, Albin S Quiko, Carol A Drastol
OBJECTIVE: This study evaluated the efficacy of IV cosyntropin as an alternative to epidural blood patch (EBP) for refractory or severe post-dural puncture headache (PDPH). METHODS: Twenty-eight patients were randomized to receive EBP or intravenous cosyntropin after diagnosis with post-dural puncture headache. Efficacy was evaluated immediately after treatment and at 1 day, 3 days, and 7 days following treatment using self-reported verbal reported scores for pain and function related to their headache on a 10-point scale using two-way repeated measures analysis of variance (ANOVA) with multiple comparisons...
March 25, 2016: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Lauren E Finn, Jennifer Gutowski, Steve Alles, Naomi Mirowitz, Caroline Johnson, Kevin C Osterhoudt, Ami Patel
In December 2011 and December 2013, the Philadelphia Department of Public Health (PDPH) received separate reports of clusters of photokeratitis linked to gymnasium events. Photokeratitis, a painful eye condition resulting from unprotected exposure to ultraviolet radiation, has previously been linked to metal halide lamps with broken outer envelopes (1,2). To investigate the cause of these clusters and further characterize patients with photokeratitis, PDPH administered questionnaires to potentially exposed persons, established a case definition, and conducted environmental assessments of both gymnasiums...
2016: MMWR. Morbidity and Mortality Weekly Report
Ingrid Arevalo-Rodriguez, Agustín Ciapponi, Marta Roqué i Figuls, Luis Muñoz, Xavier Bonfill Cosp
BACKGROUND: Post-dural puncture headache (PDPH) is a common complication of lumbar punctures. Several theories have identified the leakage of cerebrospinal fluid (CSF) through the hole in the dura as a cause of this side effect. It is therefore necessary to take preventive measures to avoid this complication. Prolonged bed rest has been used to treat PDPH once it has started, but it is unknown whether prolonged bed rest can also be used to prevent it. Similarly, the value of administering fluids additional to those of normal dietary intake to restore the loss of CSF produced by the puncture is unknown...
2016: Cochrane Database of Systematic Reviews
X An, S Wu, F He, C Li, X Fang
We report a case of refractory spontaneous intracranial hypotension (SIH) following epidural anesthesia. In this case, typical clinical symptoms and concomitant use of regional anesthesia led to the misdiagnosis of SIH as post-dural puncture headache (PDPH). A 56-year-old man received a successful appendectomy under epidural anesthesia performed at a T11-T12 intravertebral space. About 20 h later, the patient started complaining about orthostatic headache when getting up from his lying position, then a PDPH was diagnosed...
May 2016: Acta Anaesthesiologica Scandinavica
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