Open AccessCaudal Normal Saline Injections for the Treatment of Post-Dural Puncture Headache
Author(s) -
Susanne Abdulla,
Walied Abdulla,
Regina Eckhardt
Publication year - 2011
Publication title -
pain physician
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.31
H-Index - 99
eISSN - 2150-1149
pISSN - 1533-3159
DOI - 10.36076/ppj.2011/14/271
Subject(s) - medicine , post dural puncture headache , syringe , saline , anesthesia , visual analogue scale , surgery , catheter , epidural steroid injection , epidural blood patch , complication , spinal anesthesia , low back pain , alternative medicine , pathology , psychiatry
Background: Post-dural puncture headache (PDPH) is the most common complicationof procedures in which the dura mater is penetrated.Objectives: To evaluate the effectiveness of caudal saline injections as a therapeuticapproach for handling post-dural puncture headache.Study Design: Prospective observational study between 1995 and 2010.Setting: Associated teaching hospital.Methods: A 5-cm 20-gauge short-beveled needle, connected by extension tube to a 20-mL syringe filled with normal saline was used for injection. During injection in increments(limited by patient discomfort), the patients were asked continually to quantify their painexperience on a visual analog scale (VAS) and on a 0-3 verbal categorical rating scale(VRS) after 50, 80 and 100 mL of infusion over a 20 minute period.Limitations: This study is limited by its sample size, observational design, and lack oflong-term outcomes.Results: PDPH occurred in 60 of 1,716 patients undergoing dural puncture (3.5%). Itwas significantly more common in women and occurred more often in young adults.The rate was highest in the spinal catheter group (13%) and lowest in the Sprotteneedle group (0.98%). Fifty-six patients underwent caudal saline injections which wererepeated in sessions of 1-2 times a day for 1-2 days. Most patients (n = 48) needed 3or 4 (n=18) sessions. Mean volumes during the 4 sessions were 120.0 mL, 114.9 mL,106.5 mL, and 97.8 mL. Four patients were finally treated with a blood patch.Conclusions: The use of fine gauge pencil-point needles may reduce the incidenceof PDPH. The technique of repeated caudal saline injections is easy, rapid, and effectivein providing the patient with almost immediate headache relief. In cases where thistreatment fails, a blood patch should be considered. Observations from this studysuggest that randomized, controlled, double-blind studies may be warranted.Key words: Post-dural puncture headache (PDPH), dural puncture, spinal anesthesia,caudal saline injection