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Case Reports
. 2021 Mar 16;9(8):1946-1952.
doi: 10.12998/wjcc.v9.i8.1946.

Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature

Lin-Lin Song  1 , Yin Zhou  2 , Zhi-Yu Geng  2
Affiliations
Case Reports

Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature

Lin-Lin Song et al. World J Clin Cases. .

Abstract

Background: Accidental dural puncture (ADP) and subsequent post-dural puncture headache (PDPH) remain common complications of epidural procedures for obstetric anesthesia and analgesia. No clear consensus exists on the best way to prevent PDPH after ADP.

Case summary: We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch (HES) to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures. ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section (CS) and in eleven parturients receiving labor analgesia. An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients. After CS, the epidural catheter was used for postoperative pain relief over a 48-h period. After delivery in eleven cases, epidural infusion was maintained for 24 h. Thereafter, 15 mL of 6% HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal. None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.

Conclusion: An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.

Keywords: Accidental dural puncture; Case report; Epidural analgesia; Hydroxyethyl starch; Post-dural puncture headache; Prophylaxis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

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