ESRA Academy. Toyama E. Sep 8, 2016; 138362; 0200 Topic: Post-dural Puncture Headache
Emiko Toyama
Emiko Toyama

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Background and Aims:

 Post dural puncture headache (PDPH) is a recognized complication of neuraxial anesthesia which occurs in obstetric patients with a higher incidence. The common cause of PDPH is an accidental dural puncture (ADP) or spinal anesthesia (SA). The combined spinal-epidural anesthesia (CSEA) has a risk of both. The frequency of PDPH has been reported 0.5-1% in SA with 27G pencil point needle (PPN), 0.5% in epidural anesthesia (EA) and 0.88% in double-space CSEA in obstetric patients, respectively.
 The aim of this study was to examine the frequency of PDPH in patients who underwent caesarean section (CS) under CSEA in Japan.


 The frequency of PDPH were retrospectively studied in 338 patients who underwent CS under double-space CSEA between February 2014 and July 2015 at single university hospital. Anesthesia record and medical records were retrospectively reviewed. EA was performed 18-gauge Tuohy needle and SA was performed 25 or 27-gauge PPN.
 We extracted patients who complained of headache that worsened by standing or sitting up, and alleviated by lying down. Followed up the severity of headache and the frequency of cases that needed procedure.



 Five patients (1.47%) developed PDPH. One patient occurred ADP caused by EA. Headache in 4 patients could have been due to unrecognized dural puncture with the Touhy needle or to dural puncture from PPN. One patient received epidural blood patch, and four patients treated conservative.


 The overall incidence of PDPH was 1.47%.
The frequency of PDPH in double-space CSEA in patients undergoing CS was same as previous reports.

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