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THE MANAGEMENT OF ACCIDENTAL DURAL PUNCTURE AND POSTDURAL PUNCTURE HEADACHE IN CESAREAN SECTION: PROPHYLACTIC METHODS
Author(s): ,
Karaman, S.*
Affiliations:
EGE University Faculty Of Medicine, Anesthesiology And Reanimation, Izmir, Turkey
,
Sargin, A.
Affiliations:
EGE University Faculty Of Medicine, Anesthesiology And Reanimation, Izmir, Turkey
,
Gunusen, I.
Affiliations:
EGE University Faculty Of Medicine, Anesthesiology And Reanimation, Izmir, Turkey
,
Karaman, Y.
Affiliations:
The University Faculty Of Medicine Sciences, Anesthesiology And Reanimation, Izmir, Turkey
Askar, F.
Affiliations:
EGE University Faculty Of Medicine, Anesthesiology And Reanimation, Izmir, Turkey
ESRA Academy. Karaman S. Sep 13, 2017; 190821
Topic: Complications in Obstetric Population
Prof. Dr. Semra Karaman
Prof. Dr. Semra Karaman

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Abstract
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Background and Aims:

Accidental dural puncture (ADP) and post-dural puncture headache (PDPH) are important complications of regional anesthesia . The incidence of PDPH is estimated to be between 0-5% following spinal anesthesia and up to 81% following ADP during epidural catheter insertion specifically in the pregnant woman. Although usually a benign complication, PDPH can result in serious complications such as subdural hematoma and seizures, which could be fatal. Prevention of PDPH is therefore an important topic. Epidural blood patch (BP) is the most effective treatment of PDPH. Prophylactic BP has shown its efficacy to prevent PDPH; nevertheless, it may be insufficient. Inserting the catheter intrathecally after ADP to prevent PDPH has gained popularity. No clear consensus exists on how to best prevent severe headache from occurring after ADP.

Methods:

We report an ADP case before induction of caesarean section in a 32 year-old parturient. To avoid PDPH, an intrathecal catheter was immediately inserted after ADP and an epidural catheter was also inserted at the interspace above. An epidural block was established with the incremental doses of bupivacaine/fentanyl mixture. A full-term male neonate was born. Both catheters were maintained initially for 24 hours: the intrathecal catheter was kept in place to avoid Cerebrospinal fluid leakage, and the epidural one in order to make a prophylactic BP. A prophylactic BP was performed immediately after removal of the intrathecal catheter.

Results:

The patient did not experience any headache  and neurologic symptoms.

Conclusions:

After  ADP, inserting the epidural catheter intrathecally+prophylactic BP may be a good alternative approach to prevent PDPH.

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