• Dural puncture
    • Usually obvious
    • Threading a catheter may reduce PDPH
    • PDPH is about 70-90%
    • Blood patch is the treatment of choice and is effective in up to 90% at 48-72 hrs.
    • PDPH
      • Occurs hrs to days after
      • Positional in nature
      • Photophobia
      • Neck stiffness
      • Nausea, diplopia, tinnitus
      • Important differentials
        • Meningitis
        • Migraine
        • Stress
        • Encephalitis
        • SAH
        • Cortical vein thrombosis
    • Blood patch
      • Check FBC, CRP & temp prior
      • 2 anaethetists
      • Full asepsis
      • Take some blood for BCs
      • Risk of repeat puncture
      • 20mls injected over 2-3 mins
      • Can cause back pain for 48hrs
    • Treatments
      • Conservative
        • Hydration
      • Non-invasive pressure
        • Abdominal binding
      • Analgesics
        • Codeine
        • NSAIDs
        • Opioids
        • Paracetamol
      • Adjuvants
        • Caffeine
        • 5-HT1 RA
        • Theophylline
      • Invasive
        • Epidural opioids
        • Epidural fluids
        • Blood patch
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/1/3/81.full.pdf