Management of postdural puncture headache

Postdural puncture headache (PDPH), a complication of regional anesthesia, is not infrequently seen in parturients because of their inherent risk from young age and female gender. With spinal anesthesia, the risk of PDPH is mainly dependent on the size and type of needle and can be reduced with the use of small-gauge, pencilpoint spinal needles. For unintentional dural puncture with epidural needles, a prophylactic epidural blood patch can reduce the risk of PDPH. Other potentially efficacious maneuvers include insertion of an intrathecal catheter and avoidance of second- stage pushing. Treatment of PDPH includes the use of caffeine or an epidural blood patch. Other pharmacologic interventions (eg, theophylline, sumatriptan, adrenocorticotropic hormone) and epidural administration of saline or dextran 40 await further investigation. The evidence for these interventions is discussed in this review. Copyright © 2001 by W.B. Saunders Company