Year 2020 / Volume 27 / Number 2

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Cilinical Note

Clinical experience with the implementation of a postdural puncture headache multidisciplinary protocol

Rev. Soc. Esp. Dolor. 2020; 27(2): 133-137 / DOI: 10.20986/resed.2020.3782/2019

María Beatriz Perdomo, Elizabeth María Carrillo, Samuel Hernández, Álvaro Rodríguez, Elena Espinosa


ABSTRACT

Introduction: Postdural puncture headache (PDPH) is a lumbar puncture complication, this practice is used by several medical specialists for different purposes as well as the accidental dural puncture (ADP) in an epidural technique.
The objective of a PDPH multidisciplinary management protocol, is to diagnose and early treat any patient with PDPH, no matter which speciality observes this complication.
Material and methods: A descriptive, observational and retrospective study in which the clinical helpfulness of a PDPH management protocol is analyzed between September 2014 and December 2017.
Results: A total of 60 consult visits were analyzed. An incidence of ADP of 0.61 % was observed, 80 % of them developed PDPH, and out of these, 72 % required an epidural blood patching. Re-entry due to clinical worsening was required by 8 patients on telephone followup, who were initially discharged with mild PDPH, and one of them was diagnosed with abducens nerve palsy. Medical specialities with patients in this protocol were: anesthesiologists, obstetricians, emergency physicians and neurologists.
Conclusions: The protocol allowed a diagnosis and early treatment of the PDPH as well as supplied the patient’s follow-up after his hospital discharge.



RESUMEN

Introducción: La cefalea postpunción dural (CPPD) es una complicación de la punción lumbar, práctica utilizada por múltiples especialistas con diferentes fines, y de la punción dural accidental (PDA) en una técnica epidural.
El objetivo de disponer de un protocolo de manejo de la CPPD, con implicación multidisciplinar, es diagnosticar y tratar precozmente a cualquier paciente con CPPD, independientemente de qué especialidad observe la complicación.
Material y métodos: Estudio descriptivo, observacional y retrospectivo en el que se analiza la utilidad clínica de un protocolo de manejo de CPPD entre septiembre de 2014 y diciembre de 2017.
Resultados: Se analizaron un total de 60 interconsultas. Se observó una incidencia de PDA del 0,61 %, el 80 % de las PDA desarrollaron CPPD, y de ellas, el 72 % precisó un parche hemático. Con el seguimiento telefónico, 8 pacientes que inicialmente fueron dados de alta con CPPD leve precisaron reingreso por empeoramiento clínico, y se diagnosticó un paciente con parálisis del VI par craneal. Los especialistas que incluyeron pacientes en el protocolo fueron: anestesiólogos, obstetras, médicos de urgencias y neurólogos.
Conclusiones: El protocolo permitió un diagnóstico y tratamiento precoz de la CPPD, además de un seguimiento tras el alta hospitalaria del paciente.





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Bibliografía

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Instrucciones para citar

Perdomo M, Carrillo E, Hernández S, Rodríguez Á, Espinosa E. Clinical experience with the implementation of a postdural puncture headache multidisciplinary protocol. Rev Soc Esp Dolor 2020; 27(2): 133-137 / DOI: 1020986/resed20203782/2019


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Ficha Técnica

Recibido: 09/11/2019

Aceptado: 13/01/2020

Prepublicado: 16/03/2020

Publicado: 17/04/2020

Tiempo de revisión del artículo: 36 días

Tiempo de prepublicación: 128 días

Tiempo de edición del artículo: 160 días


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