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Chapter 12 - Prevention and management of postdural puncture headache

Published online by Cambridge University Press:  05 December 2011

By
L Wakely ,
S Singh  and
I McConachie
Edited by
Ian McConachie
Ian McConachie
Affiliation:
University of Western Ontario
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Summary

The prevention and management of postdural puncture headache (PDPH) in the obstetric patient continues to challenge the anesthesiologist. This chapter discusses the clinical management of PDPH in obstetric patients and suggests recommendations based on current, relevant evidence. The presence of focal neurological signs may point toward other neurological problems and prompt further investigations and assessments. The low cerebrospinal fluid (CSF) volume causes a drop in subarachnoid pressure. The incidence of PDPH in obstetric patients is relatively high due to the effects of gender and young adult age. It is also related to the size and design of the needle used and the experience of the anesthesiologist carrying out the procedure. Larger randomized controlled trials may help provide insight into the optimal use of the epidural blood patch (EBP) and other treatments. Such trials will be difficult to perform due to the low incidence of accidental dural puncture (ADP) and PDPH.

Keywords

cesarean sectioncombined spinal-epidural anesthesiacontinuousspinal anesthesiaobstetric patientslabor analgesiafetal heart rateepidural catheter
Type
Chapter
Information
Controversies in Obstetric Anesthesia and Analgesia , pp. 154 - 163
Publisher: Cambridge University Press
Print publication year: 2011

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