///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Use of IV Cosyntropin in the Management of Obstetric Patients with Postdural Puncture Headache

Abstract Number: 201
Abstract Type: Original Research

Mercy A Udoji MD1 ; Thomas Van De Ven MD2; Ashraf Habib MB, FRCA3

BACKGROUND:

The incidence of postdural puncture headache (PDPH) in obstetric patients has been found to be greater than 50% after inadvertent dural puncture with a Tuohy needle and 3% after spinal anesthesia.1,2 A number of case reports suggested that the use of IV cosyntropin might be effective in the treatment of PDPH.1,3,4 Cosyntropin is a synthetic ACTH derivative whose proposed benefits in the treatment of PDPH is increased cerebrospinal fluid production and/or increased production of endogenous endorphins.1 There are however no reports comparing the incidence of headache and the need for epidural blood patch (EBP) in patients who received or did not receive cosyntropin for the treatment of PDPH. In our unit, cosyntropin is sometimes used at a dose of 500 mcg infused over 4 hours. We therefore performed this retrospective database analysis to determine whether IV cosyntropin reduced the severity of headache or need for EBP in our obstetric patients diagnosed with PDPH.

METHODS:

We reviewed our quality improvement database on PDPH to identify women who developed PDPH after epidural/spinal anesthesia from October 1998 through December 2008. We collected information about headache severity, duration of headache, and treatments used. Those who experienced postural headaches were divided into two groups based on receipt or non receipt of IV cosyntropin. Statistical analysis was performed using the t-test and Fishers exact test. P value <0.05 was considered statistically significant.

RESULTS:

173 women with postural headaches were identified and included in the analysis. Of those, 34 patients received IV cosyntropin. There was no difference in demographics between the two groups except that patients who received cosyntropin were older (p=0.0135). There was also no difference between the groups in the duration or severity of headache. Less patients in the cosyntropin group received an EBP (27% vs. 36%), however the difference was not statistically significant (p=0.3214).

CONCLUSION:

This data suggests that IV cosyntropin does not reduce the duration or severity of headache or the need for EBP in postpartum patients with PDPH. Larger prospective studies are needed to confirm these findings.

REFERENCES:

1) Anesthesiology 2000; 92:272-4.

2) Int J Obstet Anesth 1994; 3:116.

3) Reg Anesth 1997; 22:432-4.

4) Br J Anaesth 2002; 89:782-5.



SOAP 2009