[Treatment of post-dural-puncture headache with intravenous cortisone].
Postdural puncture headache (PDPH) is the most frequent complication of procedures involving dural penetration for spinal anesthesia or following unintentional dural puncture during attempted epidural anesthesia or analgesia. PDPH causes serious problems for women who have just given birth, as they are unable to give adequate care to their infants. The causes of PDPH are poorly understood and treatments are therefore various and symptomatic; most are empirical and not all are effective. When conservative measures fail, an alternative that may be proposed is the blood patch, an invasive technique which is not without risk and which many patients reject. We report three cases of incapacitating PDPH in women after vaginal or caesarian delivery in which symptoms resolved with intravenous hydrocortisone treatment. Hydrocortisone treatment for PDPH has never been reported in the literature, but given our results, we consider that clinical trials are warranted to establish the efficacy of this treatment and to determine if there is a chance that it might offer an alternative to the blood patch.
Moral Turiel
M
M
Hospital Universitario 12 de Octubre, Centro Materno Infantil, Madrid.
Rodríguez Simón
M Oliva
MO
Sahagún de la Lastra
J
J
Yuste Pascual
J A
JA
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000773:Anesthesia, Obstetrical; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002110:Caffeine / Q000627:therapeutic use; D002585:Cesarean Section; D004172:Diplopia / Q000188:drug therapy / Q000209:etiology; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006261:Headache / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007431:Intraoperative Complications / Q000209:etiology; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D011247:Pregnancy; D011644:Puerperal Disorders / Q000188:drug therapy* / Q000209:etiology; D011677:Punctures / Q000009:adverse effects*; D014147:Tramadol / Q000627:therapeutic use
D000700:Analgesics; D000893:Anti-Inflammatory Agents; D000082:Acetaminophen; D014147:Tramadol; D002110:Caffeine; D006854:Hydrocortisone