Intravenous cosyntropin versus epidural blood patch for treatment of postdural puncture headache

Steven Richard Hanling, Joseph E. Lagrew, Derrick H. Colmenar, Albin S. Quiko, Carol A. Drastol

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective. This study evaluated the efficacy of IV cosyntropin as an alternative to epidural blood patch (EBP) for refractory or severe post-dural puncture headache (PDPH). Methods. Twenty-eight patients were randomized to receive EBP or intravenous cosyntropin after diagnosis with post-dural puncture headache. Efficacy was evaluated immediately after treatment and at 1 day, 3 days, and 7 days following treatment using self-reported verbal reported scores for pain and function related to their headache on a 10-point scale using two-way repeated measures analysis of variance (ANOVA) with multiple comparisons. Results. Baseline information for the control and study cohorts showed no difference based on intent to treat analysis. EBP showed significant improvement over cosyntropin at day 1 (P < 0.001) for VRS pain and function scores; however, cosyntropin demonstrated similar efficacy to EBP immediately after treatment and days 3 and 7 post treatment (respectively, P = 0.459, P = 0.391 and 0.925 for pain and P = 0.189 and 0.478 for function).Treatment effects remained at day 1 after multivariate analysis (P < 0.001 and P = 0.002 for pain and function, respectively). Conclusions. It is reasonable to consider IV cosyntropin as the treatment of choice for patients in whom EBP is contraindicated or in austere environments where there is limited or no access to anesthesia trained providers. Future research should compare efficacy and cost of prophylaxis to treatment of PDPH with intravenous cosyntropin and evaluate the most effective dosing regimen, including duration, number, and strength of doses.

Original languageEnglish (US)
Pages (from-to)1337-1342
Number of pages6
JournalPain Medicine (United States)
Volume17
Issue number7
DOIs
StatePublished - Jul 1 2016

Fingerprint

Epidural Blood Patch
Post-Dural Puncture Headache
Cosyntropin
Pain
Therapeutics
Headache
Analysis of Variance
Cohort Studies
Multivariate Analysis
Anesthesia
Costs and Cost Analysis

Keywords

  • Adrenocorticotropic hormone
  • Epidural blood patch
  • Postdural puncture headache
  • Technique

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Hanling, S. R., Lagrew, J. E., Colmenar, D. H., Quiko, A. S., & Drastol, C. A. (2016). Intravenous cosyntropin versus epidural blood patch for treatment of postdural puncture headache. Pain Medicine (United States), 17(7), 1337-1342. https://doi.org/10.1093/pm/pnw014

Intravenous cosyntropin versus epidural blood patch for treatment of postdural puncture headache. / Hanling, Steven Richard; Lagrew, Joseph E.; Colmenar, Derrick H.; Quiko, Albin S.; Drastol, Carol A.

In: Pain Medicine (United States), Vol. 17, No. 7, 01.07.2016, p. 1337-1342.

Research output: Contribution to journalArticle

Hanling, SR, Lagrew, JE, Colmenar, DH, Quiko, AS & Drastol, CA 2016, 'Intravenous cosyntropin versus epidural blood patch for treatment of postdural puncture headache', Pain Medicine (United States), vol. 17, no. 7, pp. 1337-1342. https://doi.org/10.1093/pm/pnw014
Hanling, Steven Richard ; Lagrew, Joseph E. ; Colmenar, Derrick H. ; Quiko, Albin S. ; Drastol, Carol A. / Intravenous cosyntropin versus epidural blood patch for treatment of postdural puncture headache. In: Pain Medicine (United States). 2016 ; Vol. 17, No. 7. pp. 1337-1342.
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AB - Objective. This study evaluated the efficacy of IV cosyntropin as an alternative to epidural blood patch (EBP) for refractory or severe post-dural puncture headache (PDPH). Methods. Twenty-eight patients were randomized to receive EBP or intravenous cosyntropin after diagnosis with post-dural puncture headache. Efficacy was evaluated immediately after treatment and at 1 day, 3 days, and 7 days following treatment using self-reported verbal reported scores for pain and function related to their headache on a 10-point scale using two-way repeated measures analysis of variance (ANOVA) with multiple comparisons. Results. Baseline information for the control and study cohorts showed no difference based on intent to treat analysis. EBP showed significant improvement over cosyntropin at day 1 (P < 0.001) for VRS pain and function scores; however, cosyntropin demonstrated similar efficacy to EBP immediately after treatment and days 3 and 7 post treatment (respectively, P = 0.459, P = 0.391 and 0.925 for pain and P = 0.189 and 0.478 for function).Treatment effects remained at day 1 after multivariate analysis (P < 0.001 and P = 0.002 for pain and function, respectively). Conclusions. It is reasonable to consider IV cosyntropin as the treatment of choice for patients in whom EBP is contraindicated or in austere environments where there is limited or no access to anesthesia trained providers. Future research should compare efficacy and cost of prophylaxis to treatment of PDPH with intravenous cosyntropin and evaluate the most effective dosing regimen, including duration, number, and strength of doses.

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