PDPH
- Develop 12-48 hours after spinal anesthesia.
- Headache improve when lying supine.
Mechanisms of PDPH
- Persistent leakage of CSF
- ↓
- Decrease in CSF volume/pressure
- ↓
- Shifts of intracranial contents
- Activating adenosine receptors
- ↓
- Stretching the meninges
- Vasodilatation of intracranial vessels
Differential Diagnosis
- Meningitis
- Sinusitis
- Migraine
- Pregnancy related hypertension
- Intracranial Pathology (sol)
- Dural Venous thrombosis
- Pneumocephalus
- Spontaneous intracranial hypotension.
PDPH; TREATMENT
- Conservative.
- Epidural blood patch.
Spinal anesthesia; single shot technique
HYPERBARIC BUPIVACAINE IS PREPARED BY MIXING IT WITH DEXTROSE
- Sterile, clear
- Preservative free
- 3 ml ampoules
- See the expiry date
- Be sure it is bupivacaine??
SYMPATHETIC, SENSORY & MOTOR BLOCKADE
- Spinal Injection
- Sympathetic block is 2 dermatomes higher than sensory block
- Motor block is 2 dermatomes lower than sensory block
- Detect the sensory level by cold sensation test,
- (Ice cubes).
DERMATOMES OF THE BODY
- Cervical vertebrae
- Thoracic vertebrae
- Lumbar vertebrae
- Sacral vertebrae
LATERAL VIEW
SPINAL ANESTHESIA
Complications
- Failed block
- Back pain (most common)
- Spinal headache
- More common in women ages 13-40
- Larger needle size increase severity
- Onset typically occurs first or second day post-op
Treatment:
- Bed rest
- Fluids
- Caffeine
- Blood patch