| Manejo efectivo de la cefalea post punción dural |
EFFECTIVE MANAGEMENT OF THE POST DURAL PUNCTURE HEADACHE
ANAESTHESIA TUTORIAL OF THE WEEK 181
31ST MAY 2010
Dr Nicola Jane Campbell FRCA
Specialist Training Registrar in Anaesthesia
Peninsula Deanery
Correspondence to nicolacampbell@doctors.org.uk!
INTRODUCTION
"Toward the evening I was forced to take to bed and remained there for nine days, because all the manifestations recurred as soon as I got up. At midnight a violent headache set in that quickly became insupportable."
August Bier 1898- a personal experience of post-dural puncture headache.
Post-dural puncture headache (PDPH) was first described by August Bier in 1898 and classically presents as a postural headache following therapeutic or diagnostic interventions of the epidural or spinal space. The incidence of PDPH is estimated to be between 30-50% following diagnostic or therapeutic lumbar puncture, 0-5% following spinal anaesthesia and up to 81% following accidental dural puncture during epidural insertion in the pregnant woman. Although PDPH usually resolves spontaneously, it is unpleasant, it may interfere with a new mothers ability to care for her newborn and it may extend the length of hospital stay. More rarely PDPH may be associated with serious complications such as subdural haematoma, seizures and saggital sinus thrombosis. Effective treatment is limited so measures including the use of suitable needles and acquisition of appropriate skills in spinal and epidural placement are essential to reduce the development of PDPH.
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