Treatment decision-making algorithm for postdural puncture headache.
- 1. When diagnosis is made, all patients should receive supportive measures (reassurance, bed rest, analgesics, hydration, quiet environment).
- 2. Severity of symptoms should be classified using VAS scale (mild 1–3, moderate 4–6, severe 7–10).
- 3. Virtually all patients will improve in time even without additional therapy. (dashed lines)
- 4. Symptoms worsen or fail to resolve within 5 days.
- 5. Patient preference dictates the choice between pharmacologic (less effective) and epidural blood patch (EBP).
- 6. In patients with severe symptoms, EBP is strongly suggested.
- 7. The most common pharmacologic measure is caffeine prescription.
- 8. The failure, worsening, or recurrence of symptoms after pharmacologic measures favors the use of EBP.
- 9. In addition to EBP, other epidural treatment options can be considered in select patients (eg, dextran, saline).
- 10. A period of 24 h should lapse before repeating EBP.
- 11. Failure of the second EBP should prompt reconsideration of the diagnosis and neurology consultation.
- 12. Insufficient data are available regarding the optimal treatment of the failed EBP. Further work-up in consultation with a neurologist or neurosurgeon is suggested.
From Neal, Rathmell (eds): Complications in Regional Anesthesia and Pain Management, copyright 2006, published by Elsevier, Philadelphia, PA, USA, with permission.
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