Post-dural puncture headache and other complications after lumbar puncture

Abstract

In pediatric hematology and oncology specialties, lumbar punctures are frequently performed for diagnostic and therapeutic purposes. Lumbar puncture is a procedure that is generally well tolerated with minimal adverse effects. However, adverse effects do occur. Post-dural puncture headache (PDPH) is the most common adverse effect after lumbar puncture. A better understanding of the pathophysiology of PDPH and attention to needle selection and technique may lessen the occurrence of PDPH. A review of the literature that addresses the variables associated with PDPH and its prevention are presented. Other adverse effects after lumbar puncture include dysesthesias, backache, transient radicular irritation, nerve palsies, infectious processes, herniation, and bleeding disorders. Although most adverse effects are mild and resolve without intervention, others require astute diagnosis and management. This review discusses the general principles in the clinical presentation of adverse effects after lumbar puncture and offers interventions for management. The prevention and the recognition and treatment of adverse effects is the role of the entire health care team that cares for children who require lumbar puncture. As such, implications for the role of nursing are essential before, during, and after a lumbar puncture and are briefly discussed.