Spinal anesthesia is the most commonly
used regional block in anesthetic practice. Central neural block (CNB) is
administered frequently for caesarean section. Post-spinal headache (PSH) is
the most frequent and discomforting late complication of spinal anaesthesia.
PSH is an important cause of iatrogenic maternal co-morbidity and maternal
dissatisfaction. The exact mechanism of headache following PSH is not clear.
Different associated symptoms may be there with PSH which may mimic other
clinical conditions presenting as headaches. Expedited discharge of the mother
or delayed onset of PSH in some women may not capture all the mothers
developing PSH after hospital discharge. The mother having PSH might first
report to the obstetrician. A pilot study in our institute, regarding knowledge
and practice of treatment of PSH amongst obstetricians demonstrated limited
knowledge of PSH. Bedrest, fluids, analgesics, caffeine, Sphenopalatine
ganglion block, and Epidural blood patch are treatment modalities commonly used
for PSH management.
Even though PSH is a self-limiting
condition, a subset of patients will suffer from potentially life-threatening
neurological consequences. Such a patient needs urgent referral to an
anaesthesiologist, neurologist, and special radiological investigations for
definitive diagnosis and treatment. Epidural Blood Patch should be considered
to treat PSH which impairs the daily activities of the patient and is
refractory to conservative therapy or the patient has other neurological
sequelae of PSH like hearing loss and cranial nerve palsy. Awareness needs to
be there amongst obstetricians regarding PSH to avoid medicolegal problems and
patients also are to be educated about red flag symptoms once they develop PSH.
This article reviews the pathophysiology,
clinical picture, and management of PSH with special considerations during the
postpartum period.
Author (s) Details
Sadhana Sudhir
Kulkarni
In-Charge Skill Development Unit, MGM Medical College and Hospital,
Aurangabad, MGMIHS University, Navi Mumbai, India.
Savani Sameer Futane
Department of Anaesthesiology, Maharashtra Postgraduate Institute of Health
Sciences, Nashik, India.
Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v9/2453
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