Accepted Manuscript Correspondence Cerebrospinal fluid pressure after epidural blood patching C. Dubost, P. Pasquier, A. Salvadori, S. Mérat, D. Benhamou, T. Geeraerts PII: DOI: Reference:
S0959-289X(14)00058-2 http://dx.doi.org/10.1016/j.ijoa.2014.04.002 YIJOA 2282
To appear in:
International Journal of Obstetric Anesthesia
Accepted Date:
5 April 2014
Please cite this article as: Dubost, C., Pasquier, P., Salvadori, A., Mérat, S., Benhamou, D., Geeraerts, T., Cerebrospinal fluid pressure after epidural blood patching, International Journal of Obstetric Anesthesia (2014), doi: http://dx.doi.org/10.1016/j.ijoa.2014.04.002
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IJOA 14-00079
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CORRESPONDENCE
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Cerebrospinal fluid pressure after epidural blood patching
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We read with great interest the article by Pratt et al.1 and would like to add some insights to
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the discussion. Magnetic resonance imaging studies performed before and after lumbar
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puncture have previously shown that reductions in intracranial cerebrospinal fluid (CSF)
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volume are frequently related to post-dural puncture headache (PDPH).2 It is likely that
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following an epidural blood patch (EBP) two mechanisms are responsible for the resolution of
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headache: the first occurs immediately and results from the increase in epidural pressure; the
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second is related to correction of CSF hypotension and maintenance of normal intracranial
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pressure (ICP) by preventing further CSF leak.3
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A non-invasive way for estimating CSF pressure is with ocular ultrasonography
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measuring optic nerve sheath diameter (ONSD). Several clinical studies have confirmed the
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accuracy of ONSD measurement by ultrasonography in detecting raised ICP.4,5 We have
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recently shown in nine subjects suffering from PDPH that ONSD increased within 10 min of
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an effective EBP (i.e. one with immediate relief of headache), whereas ONSD did not
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increase after a EBP that failed to resolve PDPH. 6 These results are in keeping with those
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published by Pratt et al. who demonstrated an increase in epidural pressure after EBP,
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although they did not find a direct correlation between lumbar epidural pressure and the
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success of an EBP. We believe it would be of great interest to use both ONSD and epidural
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pressure monitoring simultaneously. By assessing both lumbar and intracranial CSF
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compartments it may be possible to better understand the mechanism of action of an EBP.
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C. Dubost, P. Pasquier, A. Salvadori, S. Mérat
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Department of Anesthesiology and Intensive Care
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Begin Military Hospital
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Saint-Mande, France
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E-mail address:
[email protected] 30 31 32
D. Benhamou
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Department of Anesthesiology and Intensive Care
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Bicêtre University Hospital
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University Hospitals Paris-South,
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Kremin-Bicêtre, France
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T. Geeraerts
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Department of Anesthesiology and Intensive Care
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Toulouse University Hospital
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Toulouse, France
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References
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1. Pratt S Kaczka DW, Hess PE. Observational study of changes in epidural pressure and
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elastance during epidural blood patch in obstetric patients. Int J Obstet Anesth (in press)
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2. Grant R, Condon B, Hart I, Teasdale GM. Changes in intracranial CSF volume after
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lumbar puncture and their relationship to post-LP headache. J Neurol Neurosurg Psychiatry
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1991; 54: 440-2.
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3. Kroin JS, Nagalla SK, Buvanendran A, McCarthy RJ, Tuman KJ, Ivankovich AD. The
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mechanisms of intracranial pressure modulation by epidural blood and other injectates in a
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postdural puncture rat model. Anesth Analg 2002; 95: 423-9.
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4. Moretti R, Pizzi B. Ultrasonography of the optic nerve in neurocritically ill patients. Acta
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Anaesthesiol Scand 2011; 55: 644-52.
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5. Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic
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nerve sheath diameter for detection of raised intracranial pressure: a systematic review and
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meta-analysis. Intensive Care Med 2011; 37: 1059-68.
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6. Dubost C, Le Gouez A, Zetlaoui PJ, Benhamou D, Mercier FJ, Geeraerts T. Increase in
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optic nerve sheath diameter induced by epidural blood patch: a preliminary report. Br J
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Anaesth 2011; 107: 627-30.
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