A case of paradoxical presentation of a postural postdural puncture headache after combined spinal-epidural anesthesia

• Published in: Journal of clinical anesthesia Vol. 38; pp. 156 - 157
• Main Authors: Bordlee, John W., MD, Beakley, Burton D., MD, Mody, Rayomond, MD, McConville, Anne P., MD, Weed, Jonathan T., MD, McClure, Brian P., MD, Foldes, Peter J., MD, Ma, Jonathan G, Kaye, Alan D, Eskander, Jonathan P., MD, MBA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017; Elsevier Limited
• Subjects: Acetaminophen - therapeutic use; Adult; Analgesics; Analgesics, Opioid - administration & dosage; Anesthesia & Perioperative Care; Anesthesia, Epidural - adverse effects; Anesthesia, Obstetrical - adverse effects; Anesthesia, Spinal - adverse effects; Anesthetics, Local - administration & dosage; Blood pressure; Bupivacaine - administration & dosage; Cerebrospinal Fluid Leak - complications; Childbirth & labor; Combined spinal-epidural; CSE; Delivery, Obstetric - adverse effects; Drug Combinations; Dural puncture; Epidural; Female; Fentanyl - administration & dosage; Headaches; Humans; Hypertension - drug therapy; Hypertension - etiology; Ketorolac - therapeutic use; Labetalol - therapeutic use; Needles; Ondansetron - therapeutic use; Oxycodone - therapeutic use; Pain; Pain Medicine; Paradoxical postdural puncture headache; Patients; Post-Dural Puncture Headache - diagnosis; Post-Dural Puncture Headache - drug therapy; Post-Dural Puncture Headache - etiology; Posture; Preeclampsia; Pregnancy; Spinal headache; Veins & arteries; Dural puncture; Epidural; Paradoxical postdural puncture headache; Combined spinal-epidural; CSE; Spinal headache
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2016.08.024

Abstract We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation.