Experiencia clínica con la implantación de un protocolo multidisciplinar de cefalea postpunción dural

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.