Headache: second most common complication
a. frequency 0.2%-24%
b. highest incidence is in obstetrics
c. occurs within several hours, but usually in the first or second day post-puncture.
d. headache is bifrontal and occipital, often involving head, neck, and shoulders.
e. aggravated in upright position, and with coughing or straining.
f. signs and symptoms include nausea and loss of appetite, photophobia, changes in auditory acuity, tinnitus, depression, feel miserable, tearful, bed-ridden, dependent, diplopia and cranial nerve palsies.
Most common pathophysiology is loss of CSF through the puncture site with resultant intracranial tension on meningeal vessels and nerves
i.e. caused by a decrease in the amount of CSF in the subarachnoid space. This decrease in CSF causes the medulla and brainstem to drop into the foramen magnum, stretching the meninges, vessels and nerves, leading to a headache. An additional complication of decreased CSF volumes is cranial nerve palsy which leads to decreased blood supply to the nerves.
Blood patch of 10-30 cc of aseptically-drawn blood. If patient is volume-depleted, it is desirable to infuse 1000 cc IV.
i. first blood patch injection resolves 89-95% of headaches; may repeat in 24 hours;
Touy needle; place first. two people.
ii. reported complications:
□ backache: 35% J D
□ neckache: 0.9%
□ temperature elevation: 5%
□ radicular pain