Prevention of post dural puncture headache in Saudi Arabia
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20252502Keywords:
Post-dural puncture headache, Lumbar puncture, Spinal anesthesia, Epidural blood patch, PDPH prevention, Saudi ArabiaAbstract
Post-dural puncture headache (PDPH) is a common complication following lumbar puncture procedures. It can lead to significant discomfort, functional impairment, and prolonged recovery, especially among female patients, younger individuals, and those with low body mass index (BMI) or a prior history of headaches. This review aims to synthesize current evidence on the etiology, risk factors, prevention, and treatment of PDPH, with a focus on clinical practices in Saudi Arabia. A narrative literature review was conducted using databases such as PubMed, Google Scholar, and ScienceDirect. Studies were selected based on their relevance to PDPH diagnosis, management, and outcomes, with a focus on peer-reviewed articles published in the past five years. Effective prevention includes the use of smaller, non-cutting spinal needles and optimal patient positioning during lumbar puncture. While conservative treatments like hydration and analgesia offer limited relief, the epidural blood patch (EBP) remains the most effective therapeutic option, particularly when administered within 48 hours of symptom onset. The variability in protocol adherence across Saudi institutions suggests a need for national clinical guidelines. Implementing standardized practices and early intervention strategies can substantially reduce the burden of PDPH in Saudi Arabia. Further region-specific research and healthcare provider training are essential to improve patient outcomes and minimize procedural complications.
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Schyns-van den Berg AMJV, Lucas DN, Leffert LR. Postdural puncture headache: Beyond the evidence. Best Pract Res Clin Anaesthesiol. 2024;38(3):267-77. DOI: https://doi.org/10.1016/j.bpa.2024.11.004
Cognat E, Koehl B, Lilamand M, Goutagny S, Belbachir A, de Charentenay L, et al. Preventing Post-Lumbar Puncture Headache. Ann Emerg Med. 2021;78(3):443-50. DOI: https://doi.org/10.1016/j.annemergmed.2021.02.019
Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003;91(5):718-29. DOI: https://doi.org/10.1093/bja/aeg231
Li H, Wang Y, Oprea AD, Li J. Postdural Puncture Headache-Risks and Current Treatment. Curr Pain Headache Rep. 2022;26(6):441-52. DOI: https://doi.org/10.1007/s11916-022-01041-x
Alatni RI, Alsamani R, Alqefari A. Treatment and Prevention of Post-dural Puncture Headaches: A Systematic Review. Cureus. 2024;16(1):e52330. DOI: https://doi.org/10.7759/cureus.52330
Tomala S, Savoldelli GL, Pichon I, Haller G. Risk factors for recurrence of post-dural puncture headache following an epidural blood patch: a retrospective cohort study. Int J Obstet Anesth. 2023;56:103925. DOI: https://doi.org/10.1016/j.ijoa.2023.103925
Shin HY. Recent update on epidural blood patch. Anesth Pain Med (Seoul). 2022;17(1):12-23. DOI: https://doi.org/10.17085/apm.21113
Althobaiti M, Ali S, Hariri NG, Hameed K, Alagl Y, Alzahrani N, et al. Recent Advances in Smart Epidural Spinal Needles. Sensors (Basel). 2023;23(13):6065. DOI: https://doi.org/10.3390/s23136065
Tubben RE, Jain S, Murphy PB. Epidural blood patch. In StatPearls. StatPearls Publishing. 2023.
McInerney HJ, Lee M, Saunders T, Schabel J, Adsumelli RSN. Symptomatic Intrathecal Hematoma following an Epidural Blood Patch for an Obstetric Patient with Postdural Puncture Headache: A Case Report and Synthesis of the Literature. Case Rep Anesthesiol. 2020;2020:8925731. DOI: https://doi.org/10.1155/2020/8925731
Kapan A, Waldhör T, Schiffler T, Beck J, Wöber C. Diagnostic and therapeutic insights in individuals with persistent post-dural puncture headache: A cross-sectional study. Headache. 2024;64(8):1015-26. DOI: https://doi.org/10.1111/head.14790
Asmare M, Ewnetu L, Geta K. Epidural blood patch in the treatment of severe post dural puncture headache after spinal anesthesia: A rare case report. Int J Surg Case Rep. 2022;95:107256. DOI: https://doi.org/10.1016/j.ijscr.2022.107256
Jackson J, Davies P, Leggett N, Nugawela MD, Scott LJ, Leach V, et al. Systematic review of interventions for the prevention and treatment of postoperative urinary retention. BJS Open. 2018;3(1):11-23. DOI: https://doi.org/10.1002/bjs5.50114
Raggi A, Bianchi Marzoli S, Ciasca P, Cammarata G, Melzi L, Chiapparini L, et al. The Pre-Lumbar puncture Intracranial Hypertension Scale (PLIHS): A practical scale to identify subjects with normal cerebrospinal fluid pressure in the management of idiopathic intracranial hypertension. J Neurol Sci. 2021;429:118058. DOI: https://doi.org/10.1016/j.jns.2021.118058
Madan E, Hussain N, Gill JS, Simopoulos TT. The contralateral oblique fluoroscopic view is associated with a lower incidence of postdural puncture headache in patients undergoing percutaneous spinal cord stimulation. Pain Pract. 2023;23(8):886-91. DOI: https://doi.org/10.1111/papr.13265
Fan YT, Zhao TY, Chen JH, Tang YL, Song XR. Prophylactic Epidural Blood Patch or Prophylactic Epidural Infusion of Hydroxyethyl Starch in Preventing Post-Dural Puncture Headache - A Retrospective Study. Pain Physician. 2023;26(5):485-93. DOI: https://doi.org/10.36076/ppj.2023.26.485
Kambale M, Jadhav SJ. Incidence of post-dural lumbar puncture headache (PDLPH) in comparison between emergency and elective lower segment cesarean section (LSCS) with 26G Quincke-Babcock cutting-beveled spinal needle. Saudi J Anaesth. 2024;18(3):338-45. DOI: https://doi.org/10.4103/sja.sja_950_23
Oumer KE, Aychew H, Daniel T, Mekete G, Belete KG, Negash TT. Incidence and associated factors of post-dural puncture headache among orthopaedic patients after spinal anesthesia: a prospective cohort study. Ann Med Surg (Lond). 2023;85(10):4703-8. DOI: https://doi.org/10.1097/MS9.0000000000001167
Aniceto L, Gonçalves L, Gonçalves L, Alves R, Gonçalves D, Laranjo M, et al. Incidence and Severity of Post-dural Puncture Headache in Non-obstetric Patients Undergoing Subarachnoid Block. Cureus. 2023;15(10):e47442. DOI: https://doi.org/10.7759/cureus.47442
Al-Hashel J, Rady A, Massoud F, Ismail II. Post-dural puncture headache: a prospective study on incidence, risk factors, and clinical characterization of 285 consecutive procedures. BMC Neurol. 2022;22(1):261. DOI: https://doi.org/10.1186/s12883-022-02785-0
Azzi A, Saliba E, Stephan JC, Saba H, Hallit S, Chamandi S. Correlates of post-dural puncture headache and efficacy of different treatment options: a monocentric retrospective study. Br J Pain. 2022;16(2):228-36. DOI: https://doi.org/10.1177/20494637211042401
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