Abstract

POSTDURAL PUNCTURE HEADACHE IN SPINAL ANASTHESIA, PATHOPHYSIOLOGY, UPDATE IN MANAGEMENT

Dr. Falah Mahdi Abdulsahib*

ABSTRACT

Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the. rst spinal anaesthetic. Bier also gained. rst-hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal ¯uid (CSF). In the last 50 yr, the development of. ne-gauge spinal needles and needle tip modi. cation, has enabled a signi. cant reduction in the incidence of post-dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post-dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation in¯uence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post-dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post-dural puncture headache.

Keywords: Spinal needle, Lumbar puncture, Pencil-point spinal needle, Postdural puncture headache, Spinal anesthesia.