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British Journal of Anaesthesia, 2004, Vol. 92, No. 5 767-770
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Correspondence

Post-dural puncture headache: pathogenesis, prevention and treatment

J. A. Aldrete1, J. Barrios-Alarcon2, S. Sagadai3, A. Hunningher4, R. Bell4 and D. K. Turnbull5

1 Chipley, FL, USA 2 São Paulo, Brazil 3 Stockport, UK 4 London, UK 5 Sheffield, UK

The first 150 words of the full text of this article appear below.

Editor—The review article on PDPH by Turnbull and Shepherd1 emphasized that, for the needle hole to heal, it is imperative to have an inflammatory reaction on the dural wall, discarding any therapeutic modalities that do not initiate inflammation.

The authors claim that epidural blood patches (EBPs) seal the puncture by initiating an inflammatory response, whereas in fact it has been shown that they do so by blood moving from the epidural toward the subarachnoid space through the orifice until a clot is formed that would act as a ‘plug’.2 A gradient has to be established, increasing the epidural pressure to higher levels so the fluid passes into the intrathecal space and tampons the orifice. However, in most of these punctures, the superficial layer of the arachnoid is also perforated; this is precisely the meningeal layer that may initiate an inflammatory process that may progress to radiculitis3 (transient nerve root irritation) . . . [Full Text of this Article]


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