title: A simple, safe and effective approach to prevent postdural puncture headache: epidural saline injection.
abstract: 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).
  
  
  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.
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Internal Medicine/ Hematology, Erzurum, Turkey.
authors.forename: Ilhami
authors.initials: I
authors.lastname: Kiki
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Internal Medicine/ Hematology, Erzurum, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gundogdu
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Anesthesiology and Reanimation, Erzurum, Turkey.
authors.forename: H Ahmet
authors.initials: HA
authors.lastname: Alici
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Internal Medicine/ Hematology, Erzurum, Turkey.
authors.forename: Rahsan
authors.initials: R
authors.lastname: Yildirim
authors.affiliation: Atatürk University, Faculty of Medicine, Department of Internal Medicine/ Oncology, Erzurum, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Bilici
keywords: Acute lymphoblastic leukemia; Central nervous system prophylaxis; Epidural saline injection; Post-dural puncture headache