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Postdural puncture headache in the obstetric population: a new approach?
  1. João Xavier1,
  2. Sílvia Pinho1,
  3. Jorge Silva2,
  4. Catarina S Nunes3,
  5. Herminia Cabido1,
  6. Rosário Fortuna1,
  7. Rita Araújo1,
  8. Paulo Lemos1 and
  9. Humberto Machado1
  1. 1Serviço de Anestesiologia — Departamento de Anestesiologia Cuidados Intensivos e Emergencia, Centro Hospitalar e Universitário do Porto, Porto, Portugal
  2. 2Department of Anaesthesiology, Unidade Local de Saúde de Matosinhos EPE, Matosinhos, Porto, Portugal
  3. 3Departamento de Ciencias e Tecnologia — Delegação Regional do Porto, Universidade Aberta, Porto, Portugal
  1. Correspondence to Dr João Xavier, Serviço de Anestesiologia — Departamento de Anestesiologia Cuidados Intensivos e Emergencia, Centro Hospitalar e Universitário do Porto, Porto, Portugal; joaomxavier{at}gmail.com

Abstract

Background and objectives The gold standard for the treatment of postdural puncture headache (PDPH) is the epidural blood patch (EBP). Regional techniques—sphenopalatine ganglion block (SPGB), greater occipital nerve block (GONB) and trigger point infiltration (TPI)—can also be used for the treatment of PDPH. Our objective was to evaluate the efficacy of these peripheral nerve blocks (PNBs) in the treatment of PDPH.

Methods A retrospective study was conducted including all patients with PDPH in the obstetrics department of our institution between April 2016 and December 2017. Data were retrieved from clinical records regarding anesthetic technique, symptoms, treatment, Numeric Pain Score (NPS) before and after treatment, among others.

Results We observed 50 cases of PDPH: 25 following spinal anesthesia, 19 following epidural block and 6 following combined spinal-epidural. Of these, seven were managed conservatively and one received EBP as first-line treatment. The remaining 42 patients received PNB as first-line treatment. Of these, 27 received only 1 course of PNB, while 15 received 2 courses. We observed a statistically significant improvement in the NPS after the first course of blocks (n=42), with a reduction of the median NPS by 6.0 (IQR 4.0–7.5; p<0.001). Improvement was also observed after the second course of blocks (n=15), with a reduction of the median NPS of 3.5 (IQR 1.5–5.0; p=0.02). Due to treatment failure, 9 of the 42 patients treated with PNB required EBP. None of these were cases following spinal anesthesia.

Conclusion SPGB, GONB and TPI can be safe and effective options for treatment of PDPH, but do not completely eliminate the need for EBP. Prospective studies designed to identify factors associated with unsuccessful treatment are required.

  • obstetrics
  • postdural puncture headache
  • head and neck
  • acute pain
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Footnotes

  • Contributors JX designed the study, performed data collection, analysis and interpretation and drafted and revised the paper. SP designed the study, performed data collection and drafted and revised the paper. JS performed statistical analysis and participated in drafting the paper. CSN performed statistical analysis. HC and RF devised the treatment protocols studied and participated in data collection and revision of the draft paper. RA devised the treatment protocols studied, initiated the project, monitored data collection and revised the draft paper. PL devised the treatment protocols studied, participated in data collection and revision of the draft paper. HM revised the draft paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the institutional review board—requirement for informed consent was waived (local reference number: 2018.089–078).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Data are deidentified participant data. Data are available from the corresponding author (ORCID id: 0000-0003-2483-2146).

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