1.12 PDPH Flashcards
1
Q
Management of Epidural Puncture
A
Analgesic
1. Site intrathecal catheter
- Re-site same same site
- Re-site different site
- usually 1 above
- risk thread though hole - Abandon use alternative
remi PCA
2
Q
Spinal catheter for labour
A
- Anaes only top up or low dose infusion
- Low volume LA - spinal catheter protocol
- Warn patient
Motor block and hypotension - Slight reduce risk in headache
- fibrotic reaction at site with catheter - Pain controlled:
Discuss Mx
headache + follow up - Discuss w/ Obs team & cons. Anaes on call
3
Q
Risk factors for Dural puncture
A
- Technically difficult
- movement
- poor position - Abnormal anatomy
- scoli - Mult attempts
- Insertion durig contraction
- Operator experiece
- LOR Air
- Prev dural puncture
- High BMI
4
Q
Risk factors for PDPH
A
- hx of headache post partum
- Low BMI
- Large Needle
- Cutting needle
- Multiple attempts
- Dehydration
- Bed Rest
- Perpendicular needle alignment
5
Q
Management of a headache 2 days Post partpartum
A
Ful Hx and exam - likely aetiology
1. Postural element
- Pattern thru day
- Aggravating or relieving factors
- Prev Hx headache and comorbs
- Relief headache w/ abdo pressure / strain
Exclude overt Nuero signs
concerns -> r/f neuro
6
Q
Diagnosis PDPH?
A
Conservative:
- Bed rest - alleviate pain
Won aid resolution symptoms - Abdo Binders not routine
7
Q
Pharm
A
Pharm
- Fluids PO or IV
2. Analgesia Paracetamol NSAID Codeine Strong Opiate prn
- Evidence use atypical Tx weak
Caffeine 800-10000 mg / day - 8-10 cup - 5HT1 antagonists
sumitriptan - Theophylline
- Methergine
ACTH attempt increase CSF production
8
Q
Interventional
A
- Blood patch
Lies flat 2h min - aid clot
advice toilet pre
Classically reports instant relief
Serial blood patches - increase success
> 2 EBP
R.F neurology for assessment
C/I if signs of infection
- Epidural saline bolus or infusion
