BMI linked to post-dural puncture headache.
This finding expands on anecdotal reports that obese parturients rarely experience headaches following inadvertent dural puncture. "It's not just morbidly obese patients being unique, but very much a linear relationship between patients who are thin all the way through morbidly obese," said Dr. Spielman, professor of anesthesiology at the University of North Carolina, Chapel Hill.
The results could help clinicians identify patients at greatest risk of postdural puncture headaches who should be candidates for a prophylactic epidural blood patch or who may not be good candidates for continuous spinal analgesia. If a morbidly obese patient experiences a headache after receiving an epidural, etiologies other than dural puncture should be considered, he recommended.
In a study of 191 women who experienced accidental dural puncture while receiving epidural analgesia, Dr. Spielman and his colleagues compared the body mass indexes (BMIs) of 98 patients who complained of headaches that lasted more than 1 day and required some combination of narcotics, bed rest, and epidural blood patch with those of 93 patients who either had no headaches or whose headaches lasted no more than 1 day and required no special treatment.
The headache risk was greatest in the leanest women and decreased progressively as BMI, calculated at the time of delivery, increased. Headaches occurred in all of the women with BMIs of 15-20, approximately 40% of women with BMIs of 30-35, and none of the women with BMIs [greater than or equal to] 50. Anyone with a BMI [greater than or equal to] 25 is considered overweight, and a BMI [greater than or equal to] 30 is considered obese.
A panniculus may protect heavier patients by raising intraabdominal pressure, which in turn raises intraepidural pressure and prevents cerebrospinal fluid from leaking when dural punctures occur, he said.
Los Angeles Bureau
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|Title Annotation:||Risk Increases With Lower BMI|
|Publication:||OB GYN News|
|Date:||Aug 1, 2003|
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