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Lack of Corticotropin beneficial effects on postdural puncture headache
Abstract Number: T-37
Abstract Type: Original Research
Following accidental dural puncture (ADP) during labor more than 50% of parturient develop Postdural puncture headache (PDPH) (1). Various treatments including intrathecal catheter, epidural saline or morphine, and prophylactic blood patch have been studied. All have shown some efficacy but, to date, no clear recommendation can be made (1). Recently, Hakim has shown that corticotropin is beneficial in preventing PDPH when given soon after the baby is delivered (2): the study showed that women who received corticotropin had a 30% risk of developing PDPH when compared to 70% of women who received placebo(2). In our division, once ADP happens the risk of developing PDPH is 50 to 60%. As part of our quality assurance and improvement for patient safety, our obstetric anesthesiology division periodically reviews our complications and the way we can reduce them in our obstetric population. Our standard treatment of postdural puncture headache (PDPH) consists of conservative management first, then epidural blood patch in case conservative measures fail. Since corticotropin was found to be helpful in these patients (2) and some of our obstetric anesthesia division members changed their practice regarding prevention of PDPH by administetring 1 mg of intravenous corticotropin following delivery, we compared women who received corticotropin to women who did not regarding the incidence of PDPH and Epidural Blood Patch (EBP).
Among women who received corticotropin we found that: 12/22 (54%) women developed PDPH, 8/22 (36%) required a blood patch and 10/22 (46%) reported no PDPH.
Among women who did not received corticotropin we found that: 10/17 (58%) developed PDPH, 6/17 (35%) required a blood patch and 7/17 (41%) had no PDPH. The difference among groups did not reach statistical significance (Z-test P=0.89).
Our preliminary results are in contrast with the previous published study (2). Based on this analysis, we think that more data is needed to draw any conclusions regarding the use of corticotropin for preventing PDPH following ADP. A large prospective randomized trial will find out whether corticotropin will be beneficial in our patient population.
1) Apfel CC, Saxena A, Cakmakkaya OS, Gaiser R, George E, Radke O. Prevention of postdural puncture headache after accidental dural puncture: a quantitative systematic review. Br J Anaesth. 2010 Sep;105(3):255-63
2) Hakim SM. Cosyntropin for prophylaxis against postdural puncture headache after accidental dural puncture. Anesthesiology. 2010 Aug;113(2):413-20.