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Epidural hydroxyethyl starch ameliorating postdural puncture headache after accidental dural puncture

Chinese Medical Journal 2023年第1期136卷 88-95页

作者： Yin Zhou Zhiyu Geng Linlin Song Dongxin Wang Department of Anesthesiology Peking University First HospitalBeijing 100034 China

Background:No convincing modalities have been shown to completely prevent postdural puncture headache(PDPH)after accidental dural puncture(ADP)during obstetric epidural procedures.We aimed to evaluate the role of epidural administration of hydroxyethyl starch(HES)in preventing PDPH following ADP,regarding the prophylactic efficacy and side effects.Methods:Between January 2019 and February 2021,patients with a recognized ADP during epidural procedures for labor or cesarean delivery were retrospectively reviewed to evaluate the prophylactic strategies for the development of PDPH at a single tertiary hospital.The development of PDPH,severity and duration of headache,adverse events associated with prophylactic strategies,and hospital length of stay postpartum were reported.Results:A total of 105 patients experiencing ADP received a re-sited epidural catheter.For PDPH prophylaxis,46 patients solely received epidural analgesia,25 patients were administered epidural HES on epidural analgesia,and 34 patients received two doses of epidural HES on and after epidural analgesia,respectively.A significant difference was observed in the incidence of PDPH across the groups(epidural analgesia alone,31[67.4%];HES-Epidural analgesia,ten[40.0%];HES-Epidural analgesia-HES,five[14.7%];Pdural analgesia-HES strategy was significantly associated with reduced risk of PDPH following ADP(OR=0.030,95%confidence interval:0.006-0.143;Pdural catheter with continuous epidural analgesia and two doses of epidural HES,respectively,on and after epidural analgesi

关键词： accidental dural puncture Epidural analgesia Hydroxyethyl starch Postdural puncture headache Prophylaxis

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Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache:Twenty case reports and a review of the literature

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World Journal of Clinical Cases 2021年第8期9卷 1946-1952页

作者： Lin-Lin Song Yin Zhou Zhi-Yu Geng Department of Anesthesiology Peking University First HospitalBeijing 100034China

BACKGROUND accidental dural puncture(ADP)and subsequent post-dural puncture headache(PDPH)remain common complications of epidural procedures for obstetric anesthesia and analgesia.No clear consensus exists on the best way to prevent PDPH after ADP.CASE SUMMARY We report our findings in twenty parturients who underwent an incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch(HES)to prevent PDPH after ADP with a 16-gauge Tuohy needle during epidural procedures.ADP with a 16-gauge Tuohy needle occurred in nine parturients undergoing a cesarean section(CS)and in eleven parturients receiving labor analgesia.An epidural catheter was re-sited at the same or adjacent intervertebral space in all patients.After CS,the epidural catheter was used for postoperative pain relief over a 48-h period.After delivery in eleven cases,epidural infusion was maintained for 24 h.Thereafter,15 mL of 6%HES 130/0.4 was administered via the epidural catheter immediately prior to catheter removal.None of the parturients developed PDPH or neurologic deficits over a follow-up period of at least two months to up to one year postpartum.CONCLUSION An incorporated strategy of epidural analgesia followed by epidural hydroxyethyl starch may have great efficacy in preventing PDPH after ADP.

关键词： Epidural analgesia Hydroxyethyl starch accidental dural puncture Postdural puncture headache Prophylaxis Case report

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