title: Intravenous Cosyntropin Versus Epidural Blood Patch for Treatment of Postdural Puncture Headache.
abstract: OBJECTIVE
  This study evaluated the efficacy of IV cosyntropin as an alternative to epidural blood patch (EBP) for refractory or severe post-dural puncture headache (PDPH).
  
  
  METHODS
  Twenty-eight patients were randomized to receive EBP or intravenous cosyntropin after diagnosis with post-dural puncture headache. Efficacy was evaluated immediately after treatment and at 1 day, 3 days, and 7 days following treatment using self-reported verbal reported scores for pain and function related to their headache on a 10-point scale using two-way repeated measures analysis of variance (ANOVA) with multiple comparisons.
  
  
  RESULTS
  Baseline information for the control and study cohorts showed no difference based on intent to treat analysis. EBP showed significant improvement over cosyntropin at day 1 (P < 0.001) for VRS pain and function scores; however, cosyntropin demonstrated similar efficacy to EBP immediately after treatment and days 3 and 7 post treatment (respectively, P = 0.459, P = 0.391 and 0.925 for pain and P = 0.189 and 0.478 for function). Treatment effects remained at day 1 after multivariate analysis (P < 0.001 and P = 0.002 for pain and function, respectively).
  
  
  CONCLUSIONS
  It is reasonable to consider IV cosyntropin as the treatment of choice for patients in whom EBP is contraindicated or in austere environments where there is limited or no access to anesthesia trained providers. Future research should compare efficacy and cost of prophylaxis to treatment of PDPH with intravenous cosyntropin and evaluate the most effective dosing regimen, including duration, number, and strength of doses.
authors.affiliation: Departments of *Anesthesia and Pain Medicine, and.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hanling
authors.affiliation: Anesthesiology, Naval Medical Center San Diego, San Diego, California.|Department of Anesthesiology, University of Florida, Gainesville, Florida.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Lagrew
authors.affiliation: Department of Anesthesiology, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
authors.forename: Derrick H
authors.initials: DH
authors.lastname: Colmenar
authors.affiliation: Anesthesiology, Naval Medical Center San Diego, San Diego, California.
authors.forename: Albin S
authors.initials: AS
authors.lastname: Quiko
authors.affiliation: Anesthesiology, Naval Medical Center San Diego, San Diego, California.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Drastol
keywords:  Adrenocorticotropic Hormone; Epidural Blood Patch; Postdural Puncture Headache; Technique