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