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B271 Postdural puncture headache, follow up and treatment modalities: the reality of a hospital
  1. D Roriz,
  2. D Gonçalves,
  3. C Sousa and
  4. S Caramelo
  1. Centro Hospitalar de Tras os Montes e Alto Douro, Vila Real, Portugal


Background and Aims Postdural puncture headache (PDPH) is a major complication of neuraxial anesthesia which can occur following spinal anesthesia and with inadvertent dural puncture, during epidural anesthesia. Women’s, specially pregnancy women’s, are considered a group of risk for PDPH. Dural punctures during epidural placement occur with a frequency of 1.5% in the obstetric population, and around of 50% of those develop a PDPH. Hospitals should develop protocols for management of accidental dural puncture, including appropriate follow-up and indications for further management.

Methods We performed a survey of all patients treated for PDPH from January 2016 until December 2020. The patients analyzed in this study were examined by an anesthesia provider. Since december 2019, a new protocol has been developed for these situations. The forty-one womens inclued in this study started conservative measures such as: bed rest, oral hydration, analgesics and caffeine supplementation.

Results From 41 women identified, 59% reported relief of headache with the conservative treatment and 25% hadsymptomatic relief when thetreatment was associated with Sphenopalatine ganglion block (SGB). Since the implementation of this protocol, there is just a case needing an Epidural Blood Patch (EBP) due to failure of the SGB.

Conclusions Since PDPH can be incapacitating, prompt diagnosis and treatment are mandatory. Our results show that, early identification of patients with PDPH and the initiation of conservative treatment favors a positive evolution. The association of the SGB to the conservative treatment proved to be favorable, leading to a decrease for more invasive treatments.

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