Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2021; 9(8): 1946-1952
Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1946
Epidural analgesia followed by epidural hydroxyethyl starch prevented post-dural puncture headache: Twenty case reports and a review of the literature
Lin-Lin Song, Yin Zhou, Zhi-Yu Geng
Lin-Lin Song, Yin Zhou, Zhi-Yu Geng, Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China
Author contributions: Song LL collected patient data and wrote the manuscript; Zhou Y contributed in writing the manuscript; Geng ZY contributed in revising the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patients for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin-Lin Song, MD, Associate Professor, Department of Anesthesiology, Peking University First Hospital, No. 15 Xishiku Street, Xicheng District, Beijing 100034, China. songlinlinlynkia@163.com
Received: October 31, 2020
Peer-review started: October 31, 2020
First decision: November 26, 2020
Revised: November 27, 2020
Accepted: December 16, 2020
Article in press: December 16, 2020
Published online: March 16, 2021
Abstract
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.

Keywords: Epidural analgesia, Hydroxyethyl starch, Accidental dural puncture, Post-dural puncture headache, Prophylaxis, Case report

Core Tip: Accidental dural puncture (ADP) with a 16-gauge Tuohy needle occurred in nine parturients undergoing cesarean section (CS) and eleven parturients receiving labor analgesia. Through a re-sited epidural catheter, epidural analgesia was maintained at a rate of 4-5 mL/h over 48 h after CS or 24 h after labor. 15 mL of hydroxyethyl starch was administered via the epidural catheter prior to catheter removal. None of these parturients reported headache or any neurologic deficits postpartum. The incorporated strategy demonstrated great efficacy in preventing post-dural puncture headache after ADP in our case series.