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Current Pain and Headache Reports
Erschienen in: Current Pain and Headache Reports 6/2020

01.06.2020 | Other Pain (AD Kaye and N Vadivelu, Section Editor)

A Comprehensive Update on the Treatment and Management of Postdural Puncture Headache

verfasst von: Riki Patel, Ivan Urits, Vwaire Orhurhu, Mariam Salisu Orhurhu, Jacquelin Peck, Emmanuel Ohuabunwa, Andrew Sikorski, Armeen Mehrabani, Laxmaiah Manchikanti, Alan D. Kaye, Rachel J. Kaye, John A. Helmstetter, Omar Viswanath

Erschienen in: Current Pain and Headache Reports | Ausgabe 6/2020

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Abstract

Purpose of Review

The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis.

Recent Findings

PDPH is an adverse iatrogenic complication of neuraxial anesthesia that occurs following inadvertent puncture of the dura after epidural or spinal anesthesia. The overall incidence of PDPH after neuraxial procedures varies from 6 to 36%. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. PDPH is a self-limiting postural headache that most often will resolve within 1 week, without need for treatment. Various prophylactic measures have been studied; however, more studies have been recommended to be undertaken in order to establish a proven benefit.

Summary

For mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment; however, this invasive treatment is not without inherent risks. Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap; all have shown promise. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. There is still limited evidence in literature about the understanding of PDPH and optimal treatment.
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Metadaten
Titel
A Comprehensive Update on the Treatment and Management of Postdural Puncture Headache
verfasst von
Riki Patel
Ivan Urits
Vwaire Orhurhu
Mariam Salisu Orhurhu
Jacquelin Peck
Emmanuel Ohuabunwa
Andrew Sikorski
Armeen Mehrabani
Laxmaiah Manchikanti
Alan D. Kaye
Rachel J. Kaye
John A. Helmstetter
Omar Viswanath
Publikationsdatum
01.06.2020
Verlag
Springer US
Erschienen in
Current Pain and Headache Reports / Ausgabe 6/2020
Print ISSN: 1531-3433
Elektronische ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-020-00860-0

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Delir bei kritisch Kranken – Antipsychotika versus Placebo

16.05.2024 Delir Nachrichten

Um die Langzeitfolgen eines Delirs bei kritisch Kranken zu mildern, wird vielerorts auf eine Akuttherapie mit Antipsychotika gesetzt. Eine US-amerikanische Forschungsgruppe äußert jetzt erhebliche Vorbehalte gegen dieses Vorgehen. Denn es gibt neue Daten zum Langzeiteffekt von Haloperidol bzw. Ziprasidon versus Placebo.

Eingreifen von Umstehenden rettet vor Erstickungstod

15.05.2024 Fremdkörperaspiration Nachrichten

Wer sich an einem Essensrest verschluckt und um Luft ringt, benötigt vor allem rasche Hilfe. Dass Umstehende nur in jedem zweiten Erstickungsnotfall bereit waren, diese zu leisten, ist das ernüchternde Ergebnis einer Beobachtungsstudie aus Japan. Doch es gibt auch eine gute Nachricht.

Darf man die Behandlung eines Neonazis ablehnen?

08.05.2024 Gesellschaft Nachrichten

In einer Leseranfrage in der Zeitschrift Journal of the American Academy of Dermatology möchte ein anonymer Dermatologe bzw. eine anonyme Dermatologin wissen, ob er oder sie einen Patienten behandeln muss, der eine rassistische Tätowierung trägt.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

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