Postdural puncture headache (PDPH) may occur after inadvertent dura mater puncture inepidural anaesthesiaor after spinal puncture in spinal anesthesia, spinal diagnostic or therapeutic procedures. It is characterized by severe headache that occurs within 5 days following thepuncture, located in the frontal and/or occipital region, not necessarily worsened in the upright position. PDPH is associated with substantially increased postpartum risks of major neurologicand other maternal complications, underscoring the importance of early recognition, follow up andtreatment particularly in obstetrics. Despite the fact that epidural blood patch is recognized as thegold standard in the treatment of PDPH, it is not without risk andpotentially may fail. Nerve blocks andnewer therapieshave been reported that could be efficacious, easy to administer and with less risk. In this review wepresent updated evidence and potential alternative therapies in the treatment of PDPH. Continue reading
We have noted an ongoing interest for the anaesthetic practices for caesarean section (CS) throughout Europe, which may differ from one country to the other for several reasons. In a very recent EJA article, a national survey in the Czech Republic and Slovakia has shown that national audits may allow and promote focusing on education and interstate cooperation. Impressively, even if the two countries were united in the past, the rate of general anaesthesia (GA) for CS in the Czech Republic was lowered from 34 to 26% for elective and from 59 to 39% for non-elective CS. This was not the case for the neighboring Slovakia, where the rate for GA was already low. Besides, in a 2017 survey from Austria, the rate of routine use for regional anaesthesia for CS reaches almost 100% and in France has a similar trend. Continue reading
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