PubMed · 7196177
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A Fortuna. 1981. Epidural tests doses.. https://doi.org/10.1213/00000539-198108000-00016
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UNLABELLED: Post-dural puncture headache (PDPH) is a well recognised complication of spinal and epidural anaesthesia. It can also occur after diagnostic or therapeutic lumbar puncture. Few cases have been reported in children. We reviewed the literature regarding definition, aetiology, incidence, risk factors, prevention and treatment, in order to provide some recommendations. Significant factors include age, gender, needle diameter, needle tip design, orientation of the tip during puncture, previous PDPH, history of migraine and repeated attempts to achieve puncture. There is no evidence for the use of increased fluids or bed rest to prevent PDPH. Once the diagnosis is made, conservative therapy is recommended for 48 h. Persistent PDPH can be treated in several ways; an epidural blood patch is one of the most effective methods. CONCLUSION: occurrence of post-dural puncture headache after lumbar puncture in children is rare. There are conflicting data about risk factors, prevention and treatment.
PURPOSE: To report the management of a patient who developed a lumbar epidural abscess when an epidural catheter was placed three years after a thoracic sympathectomy. The possible contribution of hyperhidrosis is discussed. CLINICAL FEATURES: A 62-yr-old male had compensatory hyperhidrosis in his back after thoracic sympathectomy. The patient, who suffered from thromboangeitis obliterans, underwent lumbar (L2-3) epidural catheterization in order to improve arterial circulation and ameliorate resting pain in his left leg. On the third day after catheterization, the patient complained of a dull pain in his back. Emergency magnetic resonance imaging revealed a 12-mm abscess in the epidural space. On the tenth day after catheterization, laminotomy at the 3-4 lumbar vertebrae and local drainage were performed. A 14-mm abscess was removed from the epidural space. The patient was discharged on day 21 after catheterization without any disability. CONCLUSION: Special precautions against infection may be necessary in patients with hyperhidrosis in the area where continuous epidural catheterization is attempted.
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