Prevention of Postdural Puncture Headache Following Accidental Dural Puncture: Two Cases Report and Mini Literature Review

38 and 49 years old two women were admitted for total abdominal hysterectomy. Both patiens had no history of diabetes mellitus, hypertension, arrhytmia, myocardial ischemia, hyperkalemia, or local anaesthetic allergy. Also, there was no pathological finding in the preoperative laboratory evaluation. Initially, we planned combined spinal epidural anaesthesia (CSE) but because of accidental dural puncture (ADP), 15 mg hyperbaric bupivacaine 0.5% was injected into subarachnoid space through epidural needle for spinal anaesthesia. Later, the epidural needle was withdrawn into epidural space and a 20-gauge epidural catheter was easily placed into epidural space. At the end of the surgery, 10 ml of saline with 3 mg morphine was injected through epidural catheter and then continuous infusion of 10 ml.h-1 saline was admitted via epidural catheter during 24 hours postoperatively. A second injection of 3 mg morphine in 10 ml saline was repeated on the postoperative 24 h immediately before removal of the catheter. No patient need additional analgesic treatment and no adverse effect were observed in our two cases because of epidural morphine utilization.

Following ADP, leaving the catheter in the epidural space and the administration of morphine injection with continuous saline infusion via epidural catheter may be an alternative to reduce the post dural puncture headache (PDPH).