Postdural puncture headache

Abstract

Purpose of review: Postdural puncture headache remains the most frequent complication of neuraxial anesthesia. It can occur following uncomplicated spinal anesthesia as well as unintended dural puncture during epidural anesthesia.

Recent findings: The incidence following accidental dural puncture is not as high as previously thought--approximately 50%. There are not many maneuvers that prevent postdural puncture headache. The most promising is an intrathecal catheter as it avoids further dural puncture and seals the hole during the time it is in place, decreasing cerebrospinal fluid loss. Several means to treat a postdural puncture headache exist. Medications that increase cerebral vascular resistance are the ones advocated. Methergine (methylergonovine maleate) has been advocated for postdural puncture headache following spinal anesthesia; it has not been studied for accidental dural puncture with a large bore needle. Epidural blood patch remains the treatment of choice.

Summary: An epidural blood patch should not be performed until 24 h after dural puncture to increase its success; however, it should not be delayed beyond that period in the symptomatic patient, as this delay increases the amount of time the patient suffers.