Open AccessPost Dural Puncture Headache Following Intrathecal Drug Delivery System Placement
Author(s) -
Stephanie A. Neuman
Publication year - 2013
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.2013/16/101
Subject(s) - medicine , post dural puncture headache , epidural blood patch , retrospective cohort study , incidence (geometry) , fibrin glue , medical record , anesthesiology , surgery , population , intrathecal , complication , anesthesia , spinal anesthesia , physics , environmental health , optics
Background: Placement of an intrathecal drug delivery system (IDDS) may providesubstantial benefit to certain patients. However, placement of these devices is not withoutcomplications, and minimal data exist describing the rates of these complications. Specifically,there is a paucity of data describing the incidence of post dural puncture headache (PDPH)following IDDS placement.Objectives: The aim of this study was to identify the incidence and treatment course ofPDPH following placement of an IDDS in a retrospective review.Study Design: Retrospective assessment of medical records.Setting: Department of Pain Medicine and Anesthesiology, Mayo Clinic, Rochester, MN.Methods: Following IRB approval, 319 IDDS surgical reports in 285 patients were identifiedretrospectively over a 20 year study time period. We report demographic information, numberof dural punctures, techniques for sealing dural leak, details, and treatment course of PDPHin this population.Results: Symptoms of PDPH were recognized in 73 individual cases (23% of total proceduralvolume). Younger patient age was the only statistically significant characteristic in predictingdevelopment of a PDPH. There were no statistically significant differences found in regardsto other risk factors for PDPH development or treatment strategy employed. Seventy-ninepercent of PDPH patients were successfully managed with conservative non-interventionaltherapies (bedrest, IV fluids, analgesics, antiemetics), while 21% required progression toepidural blood or fibrin glue patch procedures for full resolution of symptoms.Limitations: Limitations include the retrospective design of the study as well as the potentialfor undocumented or improperly documented surgical techniques and/or events.Conclusion: Though the development of PDPH after IDDS implantation was found to befairly common (23% incidence), the majority of these patients had self-limited symptomsthat resolved with conservative medical management. Epidural blood patch or application ofepidural fibrin glue was therapeutically successful for the remainder of PDPH patients whowere refractory to conservative measures.Key words: Pain, intrathecal drug delivery system, pain pump, morphine, baclofen,postdural puncture headache, spinal headache