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The 12 decision making steps for post dural puncture headache treatment

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.

Comments

  1. aliyaaNovember 14, 2017 at 12:42 AM

    Informative article. Neurology is a branch of medicine dealing with disorders of the nervous system. If you want to write best neurology personal statement then come to us and get benefit.

    ReplyDelete

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