Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec;41(3):175-9.

A simple, safe and effective approach to prevent postdural puncture headache: epidural saline injection

Ilhami Kiki  1 , Mehmet Gundogdu  1 , H Ahmet Alici  2 , Rahsan Yildirim  1 , Mehmet Bilici  3
Affiliations

A simple, safe and effective approach to prevent postdural puncture headache: epidural saline injection

Ilhami Kiki et al. Eurasian J Med. 2009 Dec.

Abstract
in English, Turkish

Objective: In this study, we investigated the safety and effectiveness of epidural saline injection to prevent post-dural puncture headache (PDPH) in patients with acute lymphoblastic leukemia (ALL).

Materials and methods: Thirty-three patients with ALL undergoing induction therapy were accepted for the study. Four to six courses of intrathecal methotrexate therapy were administered to each patient for central nervous system prophylaxis. Patients were divided into two groups. Lumbar puncture (LP) was performed without any additional intervention in the first group (18 cases), whereas 20 mL of isotonic saline was injected into the epidural space in the second group (15 cases). The frequency and severity of PDPH were compared between the two groups.

Results: Thirteen patients from the first group and five patients from the second group experienced at least one PDPH episode. In total, 54 PDPH episodes were reported in both groups. The rate of headache due to the LP was significantly higher in the first group than in the second group (48.8% vs. 16.4%, p<0.001). On the other hand, the severity of pain was also significantly higher in the first group (mean pain scores were 5.6 ± 1.62 vs. 3.07 ± 1.18, p<0.001). Furthermore, two patients from the first group (11.11%) developed generalized convulsion attacks, and one of those patients experienced pulmonary arrest necessitating respiratory support. No serious complications were observed in the second group.

Conclusions: Our study shows that isotonic saline injection into the epidural space after LP is a safe and effective approach to prevent PDPH and related complications.

Amaç: Bu çalışmada Akut Lenfoblastik Lösemili (ALL) olgularda epidural salin enjeksiyonunun (ESE) Dural Ponksiyon Sonrası Başağrısı (DPSB)’ nı önlemede etkinliğini ve güvenilirliğini araştırdık.

Gereç ve yöntem: Remisyon indüksiyon tedavisi uygulanmış 33 ALL hastası çalışmaya kabul edildi. Merkezi Sinir Sistemi (MSS) profilaksisi amacıyla her bir hastaya 4 ile 6 kür İntratekal Metotreksat (İT-MTX) tedavisi uygulandı.. Hastalar iki gruba ayrıldı. Birinci grupta (18 olgu) herhangi bir ek uygulama yapılmaksızın Lomber Ponksiyon (LP) yapılırken, ikinci grupta (15 olgu) epidural mesafeye 20 ml izotonik salin enjekte edildi. İki grup arasında DPSB sıklığı ve şiddeti karşılaştırıldı.

Bulgular: Birinci gruptan 13 hasta ve ikinci gruptan 5 hasta en az bir DPSB epizodu yaşadı. Her iki grupta toplam olarak 54 DPSB epizodu gözlendi. Lomber Ponksiyona bağlı başağrısı oranı birinci grupta ikinci gruptan anlamlı olarak daha yüksekti (% 48,80 e karşı % 16,4, p<0,001). Öte yandan birinci grupta ağrının şiddeti de anlamlı olarak daha fazlaydı (ortalama ağrı skorları 5,6 ± 1,62 ye karşı 3,07 ± 1,18, p<0,001). Ek olarak ilk gruptaki iki hastada (%11,11) jeneralize konvülzyon atağı gelişmesine ve bunlardan birinin solunum desteği gerektiren pulmoner arrest ile komplike olmasına rağmen ikinci grupta herhangi bir ciddi komplikasyon gözlenmedi.

Sonuç: Bizim çalışmamız, Lomber Ponksiyon sonrası epidural mesafeye izotonik salin enjeksiyonunun DPSB ve ilişkili komplikasyonların önlenmesinde etkin ve güvenli bir yaklaşım olduğunu gösterdi.

Keywords: Acute lymphoblastic leukemia; Central nervous system prophylaxis; Epidural saline injection; Post-dural puncture headache.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Association between the number of intrathecal chemotherapy injections and development of PDPH for both groups
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Itakura H, Coutre SE. acute Lymphoblastic Leukemia in Adults. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, Means RT Jr, editors. Wintrobe’s Clinical Hematology. 12th Edition. Wolters Kluwer / Lippincott Williams & Wilkins; Philadelphia: 2009. pp. 1820–42.
    1. Armitage JO, Longo DL. Malignancies of Lymphoid Cells. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s Principles of Internal Medicine. 16th Edition. McGRAW – HILL Co; New York: 2005. pp. 641–55.
    1. Oedit R, van Kooten F, Bakker SL, Dippel DW. Efficacy of the epidural blood patch for the treatment of post lumbar puncture headache BLOPP: a randomized, observer-blind, controlled clinical trial. BMC Neurol. 2005:5–12. - PMC - PubMed
    1. Gaiser R. Postdural puncture headache. Curr Opin Anaesthesiol. 2006;19:249–53. - PubMed
    1. Ahmed SV, Jayawarna C, Jude E. Post lumbar puncture headache: diagnosis and management. Postgrad Med J. 2006;82:713–6. - PMC - PubMed

LinkOut - more resources