Post-dural Puncture Headache

Postdural puncture headache is one of the complications of central blockades.  It arises most often in connection with a previous puncture of  epidural or spinal space as a result of perforation of the dura mater and arachnoidea. A cerebrospinal fluid is leaking from the gap in dura mater. It leads to a drop  of pressure of cerebrospinal fluid and it can cause headaches. The following algorithm will try to bring the diagnosis and the treatment of this condition.

epidural anesthesia
postdural puncture headache
blood patch
Published at: 2.5.2012


Pavlína Nosková, MD, PhD
Deputy of Chief Obstetric Anaesthesiologist, Dept. of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, Charles University in Prague; General University Hospital, Prague, Czech Republic Member of Expert Committee of Labor Anesthesia and Analgesia of the Czech Society of Anesthesiology and Intensive Care Medicine

Post-dural puncture headache is one of the most feared complications of anesthetists performing obstetric anesthesia and analgesia. Even in the hands of experienced colleagues, its incidence varies between 0.16 to 1.3%. Due to the necessary to mobilize the patient and the care of newborn is appropriate to solve effectively this complication. Referred algorithm is a logical therapeutic procedure and clearly brings anesthesiologist over the initial conservative therapy also to conventional invasive solution. The topic for discussion may be required laboratory tests needed to neuraxial puncture in obstetrics, which nowadays accords with practices in any workplace. The literature shows that in case of monitored physiological pregnancy is sufficient blood count value during the first and third trimester while there are no signs of mucosal and cutaneous bleeding manifestations. 


ŠTOURAČ, Petr, Jan BLÁHA, Pavlína NOSKOVÁ, Radka KLOZOVÁ a Dagmar SEIDLOVÁ. Současné postupy v porodnické anestezii IV. – anesteziologické komplikace u císařského řezu. Anesteziologie a intenzivní medicína. 2014, 25(2), 123-134. ISSN 1214-2158. Dostupné také z:

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