Suboccipital Muscles Injection for Management of Post-Dural Puncture Headache After Cesarean Delivery: A Randomized-Controlled Trial

Mhamed Abdelraouf; Maged Salah; Mohsen Waheb; Ahmed Elshall

doi:10.3889/oamjms.2019.105

Authors

Mhamed Abdelraouf Cairo University, Cairo, Egypt
Maged Salah Cairo University, Cairo, Egypt
Mohsen Waheb Cairo University, Cairo, Egypt
Ahmed Elshall Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2019.105

Keywords:

Suboccipital muscles injection, management, post-dural puncture headache

Abstract

INTRODUCTION: Post-dural puncture headache (PDPH) is a common complication following neuraxial anaesthesia that increases the duration of hospital stay.

AIM: This study aims to evaluate the effectiveness of injection of the dexamethasone-lidocaine mixture in suboccipital muscles treatment of PDPH after cesarean section.

PATIENT AND METHODS: A group of 90 females with PDPH following cesarean section under spinal anaesthesia were randomly allocated into two equal groups: study group (Group S) and control group (group C). All patients received bilateral intramuscular (in the suboccipital muscle) (Group S) (n = 45) patients received lidocaine 40 mg (2 mL of 2% solution) and dexamethasone 8mg in a total volume of 4 mL; whilst, patients in the control group (group C) (n = 45) received 4 mL normal saline. The primary outcome is the Visual Analogue Score for a headache at 24 hours after injection.

RESULTS: Demographic data and the baseline, headache score, neck muscle spasm, and nausea were comparable in both groups. Group S showed lower headache score compared to group C at all the post-injection time points. All patients in group S showed resolution of nausea after the intervention; while none of the control group showed any improvement. All patients of group C needed rescue analgesia; while only 6 (13.3%) patients in group S asked for an analgesic. Time to the first analgesic request was longer in group S compared to group C (10.17 Â± 7.96 hours versus 1.00 Â± 0.00 hours, P < 0.001).

CONCLUSION: Ultrasound-guided injection of the dexamethasone-lidocaine mixture in suboccipital muscles is effective management of PDPH after CS.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

LÃ³pez Correa T, GarzÃ³n SÃ¡nchez JC, SÃ¡nchez Montero FJ, Muriel Villoria C. Postdural puncture headache in obstetrics. Rev Esp Anestesiol Reanim. 2011; 58(9):563-573. https://doi.org/10.1016/S0034-9356(11)70141-4

Thew M, Paech MJ.Management of postdural puncture headache in the obstetric patient. CurrOpinAnaesthesiol. 2008; 21(3):288-292. https://doi.org/10.1097/ACO.0b013e3282f8e21a

Evans R. Complications of lumbar puncture. Neurol Clin. 1998; 16:83-105. https://doi.org/10.1016/S0733-8619(05)70368-6

Spencer HC. Postdural puncture headache: what matters in technique. Reg Anesth Pain Med. 1998; 23:374-379. https://doi.org/10.1097/00115550-199823040-00010

Carbaat PA, van Crevel H. Lumbar puncture headache: Controlled study on the preventive effect of 24 hours' bed rest. Lancet. 1981; 2:1133-1135. https://doi.org/10.1016/S0140-6736(81)90586-9

Alireza Mahoori, Heydar Noroozinia, Ebrahim Hasani, and Hadi Saghaleini. Comparing the effect of pregabalin, gabapentin, and acetaminophenon post-dural puncture headache. Saudi J Anaesth. 2014; 8(3):374â€“377. https://doi.org/10.4103/1658-354X.136436 PMid:25191190 PMCid:PMC4141388

Alam MR, Rahman MA, and Ershad R. Role of very short-term intravenous hydrocortisone in reducing postdural puncture headache. J Anaesthesiol Clin Pharmacol. 2012; 28(2):190-193. https://doi.org/10.4103/0970-9185.94840 PMid:22557741 PMCid:PMC3339723

Basurto Ona X, Osorio D, Bonfill Cosp X. Drug therapy for treating post-dural puncture headache. Cochrane Database Syst Rev. 2015; 15:(7). https://doi.org/10.1002/14651858.CD007887.pub3

Hodgson C, Roitberg-Henry A. The use of sumatriptan in the treatment of postdural puncture headache. Anaesthesia 1997; 52:808. PMid:9291788

Camann WR, Murray RS, Mushlin PS, Lambert DH. Effects of oral caffeine on postdural puncture headache. A double-blind, placebo-controlled trial. Anesthesia and analgesia. 1990; 70(2):181-4. https://doi.org/10.1213/00000539-199002000-00009

PMid:2405733

Malhotra S. All patients with a postdural puncture headache should receive an epidural blood patch. Int J Obstet Anesth. 2014; 23(2):168-170. https://doi.org/10.1016/j.ijoa.2014.01.001 PMid:24656528

Vilming ST, Titus F. Low cerebrospinal fluid pressure In: Oleson J, T Felt- Hansen P, Wetch K, (eds). The headaches. New York, NY: Raven, 1993:687-695.

KahkeshaniK, and Ward PJ. Connection between the spinal dura mater and suboccipital musculature: evidence for the myodural bridge and a route for its dissection--a review. Clin Anat. 2012; 25(4):415-422. https://doi.org/10.1002/ca.21261 PMid:22488993

KaradaÅŸ Ã–, GÃ¼l HL, Inan LE. Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache. J Headache Pain. 2013; 14:44. https://doi.org/10.1186/1129-2377-14-44 PMid:23698019 PMCid:PMC3671170

VenÃ¢ncio Rde A, Alencar FG, Zamperini C. Different substances and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2008; 26(2):96-103. https://doi.org/10.1179/crn.2008.014 PMid:18468269

Venancio Rde A, Alencar FG Jr, Zamperini C. Botulinum toxin, lidocaine, and dry-needling injections in patients with myofascial pain and headaches. Cranio. 2009; 27(1):46-53. https://doi.org/10.1179/crn.2009.008 PMid:19241799

David M. Biondi, DO. Cervicogenic Headache: A Review of Diagnostic and Treatment Strategies. 2005; 105(4):16S-22S.

Mellick LB, McIlrath ST, Mellick GA. Treatment of headaches in the ED with lower cervical intramuscular bupivacaine injections: a 1-year retrospective review of 417 patients. Headache. 2006; 46(9):1441-1449. https://doi.org/10.1111/j.1526-4610.2006.00586.x PMid:17040341

Cohen-Gadol AA, Mokri B, Piepgras DG, Meyer FB, Atkinson JL. Surgical anatomy of dural defects in spontaneous spinal cerebrospinal fluid leaks. Neurosurgeryn. 2006; 58(4):238-245. https://doi.org/10.1227/01.NEU.0000204712.16099.FB

Matute E, Bonilla S, Girones A. Bilateral greater occipital nerve block for post-dural puncture headache. Anaesthesia. 2008; 63:551-560. https://doi.org/10.1111/j.1365-2044.2008.05531.x PMid:18412667

Naja ZM, AL-Tannir MA, EL-Rajab M, Ziad FM, Baraka A. Nerve stimulator-guided occipital nerve blockade for postdural puncture headache. Pain Pract. 2009; 9:51-58. https://doi.org/10.1111/j.1533-2500.2008.00238.x PMid:19019052