Anaes Cases · Neuraxial anaesthesia
Post-dural puncture headache
A focused PDPH case — the postural headache from the accidental dural puncture, the conservative management, and the epidural blood patch for the severe or persistent case.
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ANZCAFRCAABAEDAIC
Prompt
A 30-year-old woman had an epidural for labour analgesia. She now has a severe frontal headache that is worse on standing and relieved by lying flat. Discuss the diagnosis and management.
Presentation
A 30-year-old woman had an epidural for labour analgesia. The anaesthetist noted a 'wet tap' (the accidental dural puncture with the Tuohy needle). Two days later she has a severe frontal headache that is worse when she stands and relieved when she lies flat, with some neck stiffness.
References2ShowHide
- [1]Cook TM, et al. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists. British Journal of Anaesthesia, 2009.PMID 19139027
- [19139028]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.