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Post epidural headache11/5/2023 Although there have been advances in the therapeutic epidural blood patch for PDPH treatment, it may cause chronic backache and a variety of neurological consequences. Hydration and abdominal binder had insufficient evidence in the treatment of obstetric PDPH. However, bed rest may increase the risk of thromboembolic complications. Several conservative treatments are recognized, including bed rest, hydration, and abdominal binder. PDPH may develop as chronic postpartum headache, causing hearing loss, backache, neckache, postpartum depression, and decreased breastfeeding. However, some PDPH can be delayed for months afterward. PDPH symptoms often start within 48 to 72 h after the operation and resolve spontaneously within 1 week. Pregnancy, female sex, and young age are all established risk factors for PDPH, which are frequently observed in obstetric patients. In spite of developments in needle design and puncture techniques, PDPH remains the most common complication of neuraxial blockade due to the popularity of neuraxial blockade in obstetric anesthesia. A recent meta-analysis revealed that the incidence of PDPH was 23.47% in a total of 175,652 parturients who underwent Caesarean section with spinal anesthesia. Previous studies demonstrated that PDPH had a wide range of incidences: 1.5% to 36% after spinal anesthesia. Post-dural puncture headache (PDPH) is a serious complication of the neuraxial blockade that may arise after spinal anesthesia or epidural analgesia with an accidental dural puncture. Better-designed studies are requested to verify these conclusions. No significant side effects were revealed. Conclusionsīased on available data, PPF, OND, and AMP may have better efficacy in decreasing the incidence of PDPH compared to the placebo group. No significant difference in other outcomes was found among different therapies. PPF and OND had the lower incidence of PONV compared to the placebo group (OR = 0.07, 95% CI: 0.01 to 0.30 and OR = 0.12, 95% CI: 0.02 to 0.63). The analyses demonstrated that PPF, OND, and AMP were efficient in decreasing the cumulative incidence of PDPH during the follow-up period compared to the placebo group (OR = 0.19, 95% CI: 0.05 to 0.70 OR = 0.37, 95% CI: 0.16 to 0.87 OR = 0.40, 95% CI: 0.18 to 0.84, respectively). Twenty-two randomized controlled trials with 4,921 pregnant women (2,723 parturients received prophylactic pharmacological therapies) were included. Secondary outcomes included the incidence of PDPH at 24 and 48 h postoperatively, the severity of headache in PDPH patients (24, 48, and 72 h postoperatively), and postoperative nausea and vomiting (PONV). The primary outcome was the cumulative incidence of PDPH within 7 days. Seven pharmacological therapies (aminophylline (AMP), dexamethasone, gabapentin/pregabalin (GBP/PGB), hydrocortisone, magnesium, ondansetron (OND), and propofol (PPF)), were studied in this Bayesian network meta-analysis. The efficacy of prophylactic pharmacological therapies remains controversial. PDPH usually occurs after Caesarean section in obstetric patients. Post-dural puncture headache (PDPH) is a major complication of neuraxial anesthesia.
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