///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Cosyntropin in the Prevention and Treatment of Post Dural Puncture Headache. Time for Revisit

Abstract Number: T2H-273
Abstract Type: Original Research

Omar A Alyamani MBBS1 ; Shobana Bharadwaj MBBS2; Bhavani Kodali MBBS3; Jessica Galey MD4; Andrew Malinow MD5

Cosyntropin in the Prevention and Treatment of Post Dural Puncture Headache. Time for Revisit

Introduction: Post Dural Puncture Headache (PDPH) is one of the most common complications of dural puncture whether accidental or intentional following neuraxial labor analgesia. Incapacitating symptoms lasting one week occurred in 39% patients with PDPH. The incidence of Dural Puncture (ADP) with 16-18 gauge epidural needles in obstetric anesthesiology practice is around 1%. About 60% of the cases with ADP developed PDPH and more than half required an Epidural Blood Patch (EBP). Cosyntropin is considered as reasonable choice for treatment of PDPH when EBP is contraindicated or in areas where expertise to perform EBP is lacking. Cochrane review showed a statistically significant decrease in PDPH by 50% and the need for EBP by 63% after ADP. Despite this review, the clinicians are skeptic to use Cosyntropin as prophlaxis or treatment for PDPH. For few years at this Institution, CoSyntropin is being used as prophylactic measure to decrease PDPH. The purpose of this study is to retrospectively evaluate the effectiveness of Cosyntropin in the prevention of PDPH, or the need for EBP.

Methods:This is a retrospective study looking at the incidence of PDPH requiring conservative therapy or EBP after intentional or accidental dural puncture with epidural needle for labor analgesia. After IRB approval the data of 178 obstetric patients who had accidental dural puncture between the years of 2002 and 2015 was evaluated. Any patients with previous history of headaches were excluded. The cases of DP before the implementation of CoSyntropin protocol constituted historical control group. Whereas all patients subsequent to introduction of the protocol constituted the study group. The protocol consisted of administering intravenous CoSyntropin 750 µg in one liter of Ringer Lactate over 8 hr soon after delivery in all patients who had known DP. A second dose was administered if the patient reported headache.

Results: Historical control group consisted of 130 patients. Thirty patients (23%) developed headache in the postpartum period and some received EBP. In the 48 patients who constituted the study group who received prophylactic or prophylactic and second dose of IV Cosyntropin, 2 patients (4.3%) developed postpartum PDPH and one received an EBP for severity. There is statistically significant decrease in the incidence of headache following ADP in CoSyntropin group. Although there was trend towards low incidence of EBP in the CoSyntropin group, it did not reach statistical significance.

Conclusion: IV Cosyntropin could potentially be a preventive and/or therapeutic option for PDPH after dural puncture and may decrease headache at discharge following labor and delivery. Trend towards a decreasing need for EBP requires further elucidation.

SOAP 2019