Post Dural Puncture Headache After Accidental Dural Puncture

Study Overview
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Brief Summary
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Epidural anesthesia is associated with potential risks and complications, post dural puncture headache (PDPH) one of the most recognized with epidural or spinal anesthesia. Accidental dural punctures occur with approximately 1.5% of all epidural attempts. Studies have suggested that the use of an intrathecal catheter reduces the incidence of PDPH. A systematic review of the existing literature will identify if there is reliable evidence to support this theory. A secondary outcome, headache severity, will also be explored via incidence rates of epidural blood patch, as this intervention is performed as a treatment for the most severe headaches.

Detailed Description
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Post dural puncture headache (PDPH) is one of the recognized complications experienced with epidural or spinal anesthesia, resulting from needle puncture of the dura layer of the meninges. This puncture can be deliberate (during spinal anesthesia) or accidental (during epidural anesthesia). Dural punctures allow a leak of cerebrospinal fluid, leading to the characteristic syndrome of PDPH; also known as a spinal headache or low-pressure headache. Accidental dural punctures occur with approximately 1.5% of all epidural attempts. Studies have estimated that, within the obstetrical population, headaches resulting from an inadvertent dural puncture are as high as 50% to 75%. As the risk of accidental dural punctures (ADP) cannot be eliminated, research has focused on possible interventions that may be taken in order to avoid the onset of a PDPH, eliminate its severity, or treat effects. One of the most common and effective treatments being an epidural blood patch (EBP). More recently, threading the epidural catheter directly into the intrathecal space after the dural puncture has been recognized as a viable option.

Official Title
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Systematic Review: Post Dural Puncture Headache After Accidental Dural Puncture: Does Insertion of Spinal Catheter Decrease Incidence of Headaches?

Conditions
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Post Dural Puncture Headache

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: any comparative methodology, including case-control studies, cohort studies, randomized clinical trials, and chart reviews. Insertion of the epidural catheter into the intrathecal space at the level of dural puncture, was compared to resiting an epidural catheter at another level Exclusion Criteria: Any intentional dural punctures (spinal anesthesia) or use of spinal microcatheters were excluded
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Epidural Resite<br>After ADP, those patients who receive an epidural resite. | |
| Spinal catheter<br>After ADP, those who receive the epidural catheter into the spinal space | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of PDPH after epidural resite versus Number of PDPH after insertion of epidural catheter into spinal space | Review of literature that compares two interventions - resiting the epidural or insertion of epidural catheter into spinal space. The Primary outcome measure will be the number of post dural puncture headache events in each group. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| What is the incidence of epidural blood patches (EBP)? | Looking at the incidence of EBP in the spinal catheter group, in comparison to the resited epidural group. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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post dural puncture headache, accidental dural puncture, PDPH, ADP, spinal catheter, epidural catheter, intrathecal catheter, dural puncture, systemic review