Bilateral greater occipital nerve block for post-dural puncture headache.

نویسندگان

  • E Matute
  • S Bonilla
  • A Gironés
  • A Planas
چکیده

rhythms (for example, by temporary transcutaneous pacing, magnet). • The often-given recommendation of application of the 'current in a fashion that it will not cross the generator ⁄ lead ⁄ chest system' might be of less relevance than currently thought. In our case, repositioning the return electrode away from the apex of the heart did not result in any change of the current necessary to transiently inhibit the pacemaker.trical nerve localization: effects of cuta-neous electrode placement and duration of the stimulus on motor response. and management of patients with pacemakers and implantable cardio-verter defibrillators. Bilateral greater occipital nerve block for post-dural puncture headache Post-dural puncture headache (PDPH) is a frequent complication of procedures involving dural penetration for spinal anaesthesia, or following unintentional dural puncture during attempted epi-dural anaesthesia or analgesia. The International Headache Society has defined a PDPH as a bilateral headache that develops within 7 days and disappears within 14 days after the dural puncture. The headache worsens within 15 min of assuming an upright position and improves within 30 min of resuming the recumbent position [1]. The greater occipital nerve is formed by sensory fibres that originate in the C2 and C3 segments of the spinal cord. Its cutaneous sensory distribution extends over the posterior part of the head, spreading anteriorly to the vertex towards the area supplied by the ophthal-mic division of the trigeminal nerve [2]. We present two cases of PDPH treated successfully with bilateral blockade of the greater occipital nerve. The first case was young healthy male who underwent surgery for umbilical herniorrhaphy. Spinal blockade was performed with a Whitacre 27 G needle. On the second postoperative day the patient complained of the typical symptoms of cervico-frontal PDPH. Conservative treatment was commenced with postural measures, hydration, caffeine and conventional analgesia. His symptoms did not improve and IV hydrocortisone was added the next day. Bilateral blockade of the greater occipital nerve was performed with bupivacaine 0.25% 4 ml and triamcinolone 20 mg. The headache completely disappeared a few minutes after the blockade. The patient was discharged on the fifth postoperative day. The second case was healthy young woman who developed a PDPH 40 h after accidental dural puncture during epidural blockade for labour analgesia. The catheter was left intrathecal during labour and after delivery we administered 0.9% saline 10 ml through the catheter. Conservative management, as in the first case, with IV hydrocortisone was started. The …

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عنوان ژورنال:
  • Anaesthesia

دوره 63 5  شماره 

صفحات  -

تاریخ انتشار 2008