Anatomical and physiological factors for a lower incidence of post-dural puncture headache during thoracic spinal anesthesia. Narrative review
- Journal of Anesthesia & Critical Care: Open Access
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Luiz Eduardo Imbelloni,<sup>1</sup> Richa Chandra,<sup>2</sup> Patrícia Falcão Pitombo,<sup>3</sup> Kartik B Sonawane,<sup>4</sup> Anna Lúcia Calaça Rivoli,<sup>5</sup> Sylvio Valença de Lemos Neto,<sup>6</sup> Felipe Bufaiçal Rassi Carneiro,<sup>7</sup> Nathalia Bufaiçal Rassi Carneiro,<sup>8</sup> Maria Carolina Padovani<sup>9</sup>
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Abstract
Post-dural puncture headache (PDPH) is a side effect of the first spinal anesthesia and can
also occur after an accidental dural puncture during epidural anesthesia. The risk of PDPH
can be influenced by the size, shape, and orientation of the spinal needles, as well as the
patient’s posture. Leakage of cerebrospinal fluid (CSF) through the dura mater opening
leads to traction on pain-sensitive structures, causing PDPH. There are various proposed
mechanisms explaining how headaches are brought on by CSF hypotension. Spinal CSF
dynamics are sensitive to varying respiratory performances. Since the beginning of the last
century, subarachnoid blocks can be performed at any of the thoracic and lumbar spinal
levels. Thoracic spinal anesthesia has been extensively studied in the 21st century, as have
several new indications for spinal anesthesia. Thoracic spinal anesthesia (TSA) has been
extensively studied in the 21st century, as have several new indications for spinal anesthesia.
Several published articles on TSA demonstrate its safety, with a lack of neurological
complications, particularly PDPH. Several mechanisms have been implicated in the lower
incidence of thoracic puncture compared to lumbar puncture. This article shows several
mechanisms for this lower incidence, and the low incidence after TSA compared with
lumbar spinal anesthesia (LSA).
Keywords
Thoracic spinal anesthesia, post-dural puncture headache, cerebrospinal fluid
