Post Dural Puncture Headache After Accidental Dural Puncture
Epidural anesthesia is associated with potential risks and complications, post dural puncture headache (PDPH) one of the most recognized with epidural or spinal anesthesia. Accidental dural punctures occur with approximately 1.5% of all epidural attempts. Studies have suggested that the use of an intrathecal catheter reduces the incidence of PDPH. A systematic review of the existing literature will identify if there is reliable evidence to support this theory. A secondary outcome, headache severity, will also be explored via incidence rates of epidural blood patch, as this intervention is performed as a treatment for the most severe headaches.
Post Dural Puncture Headache
|Study Design:||Time Perspective: Retrospective|
|Official Title:||Systematic Review: Post Dural Puncture Headache After Accidental Dural Puncture: Does Insertion of Spinal Catheter Decrease Incidence of Headaches?|
- Number of PDPH after epidural resite versus Number of PDPH after insertion of epidural catheter into spinal space [ Time Frame: 1 year ] [ Designated as safety issue: No ]Review of literature that compares two interventions - resiting the epidural or insertion of epidural catheter into spinal space. The Primary outcome measure will be the number of post dural puncture headache events in each group.
- What is the incidence of epidural blood patches (EBP)? [ Time Frame: 1 year ] [ Designated as safety issue: No ]Looking at the incidence of EBP in the spinal catheter group, in comparison to the resited epidural group.
|Study Start Date:||June 2011|
|Estimated Primary Completion Date:||December 2011 (Final data collection date for primary outcome measure)|
After ADP, those patients who receive an epidural resite.
After ADP, those who receive the epidural catheter into the spinal space
Post dural puncture headache (PDPH) is one of the recognized complications experienced with epidural or spinal anesthesia, resulting from needle puncture of the dura layer of the meninges. This puncture can be deliberate (during spinal anesthesia) or accidental (during epidural anesthesia). Dural punctures allow a leak of cerebrospinal fluid, leading to the characteristic syndrome of PDPH; also known as a spinal headache or low-pressure headache. Accidental dural punctures occur with approximately 1.5% of all epidural attempts. Studies have estimated that, within the obstetrical population, headaches resulting from an inadvertent dural puncture are as high as 50% to 75%.
As the risk of accidental dural punctures (ADP) cannot be eliminated, research has focused on possible interventions that may be taken in order to avoid the onset of a PDPH, eliminate its severity, or treat effects. One of the most common and effective treatments being an epidural blood patch (EBP). More recently, threading the epidural catheter directly into the intrathecal space after the dural puncture has been recognized as a viable option.
|Principal Investigator:||Lynn Haslam, RN MN/ACNP||Sunnybrook Health Sciences Centre, Toronto|
|Principal Investigator:||Eric Goldszmidt, MD FRCPC||Mount Sinai Hospital, Toronto|