• Alexander Ioscovich, Yaara Giladi, Rivka Leah Fuica, Carolyn F Weiniger, Sharon Orbach-Zinger, Yaacov Gozal, and Daniel Shatalin.
• Department of Anesthesiology, Perioperative Medicine & Pain Treatment, Shaare Zedek Medical Center, affiliated with the Hadassah-Hebrew University Medical School Ein-Kerem, Jerusalem, Israel.
• Acta Anaesthesiol Scand. 2018 Nov 1; 62 (10): 1460-1465.

BackgroundAccidental dural puncture frequency among pregnant women is about 1.5%, while approximately 60% of these women will suffer from post-dural puncture headache (PDPH) that may be debilitating.MethodsFollowing IRB approval, we conducted a national survey of the lead anesthesiologist in 23 labor and delivery rooms in Israel. Each survey inquired about medical center annual delivery volume, training program for residents, accidental dural puncture management, processing of information, and PDPH management strategies.ResultsData were collected from all 23 surveyed hospitals. As for methods for PDPH prevention, in most hospitals (87%) a prophylactic epidural blood patch (EBP) is not considered. Injection of epidural normal saline after delivery as a preventive measure is never considered in most (78.3%) hospitals, while four (17.4%) hospitals reported of constitutive use of this technique and one hospital only occasionally. Duration of conservative treatment was 24-48 hours in 95.7% of PDPH cases.ConclusionIn this survey, different aspects of treatment and PDPH management were examined. EBP is considered the gold standard in treating PDPH, although prophylactic blood patch is ineffective. We observed a tendency of very low performance of both prophylactic EBP and epidural normal saline administration after delivery in most centers. Most hospitals perform EBP after 24-48 hours of conservative treatment, along with published recommendations that show increased EBP efficiency with this timeframe. In light of the survey information, we aim to reach a uniform literature-based management strategy across Israeli hospitals.© 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

14 keywords...

hide…