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Top Tweets for #PdPh

anesthesianews's profile image
Anesthesiology News Verified account @anesthesianews
Dural puncture → EBP. 11 days later, labor DPE = rapid, effective, no PDPH return. Bottom line: Epidural/CSE/DPE remain options soon after EBP. https://t.co/DUTLrHH4oE #Anesthesia #MedTwitter #PDPH #Epidural #OBAnes #FOAMed #ObGyn
anesthesianews's tweet photo. Dural puncture → EBP. 11 days later, labor DPE = rapid, effective, no PDPH return. Bottom line: Epidural/CSE/DPE remain options soon after EBP. https://t.co/DUTLrHH4oE #Anesthesia #MedTwitter #PDPH #Epidural #OBAnes #FOAMed #ObGyn https://t.co/qcIK8zJtPs
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anesthesianews's profile image
Anesthesiology News Verified account @anesthesianews
After accidental dural puncture and EBP, a laboring patient received DPE 11 days later—rapid, effective analgesia, no return of PDPH. What this means for neuraxial choices in labor: https://t.co/DUTLrHH4oE #Anesthesia #Epidural #DPE #PDPH #MedTwitter #ObGyn
anesthesianews's tweet photo. After accidental dural puncture and EBP, a laboring patient received DPE 11 days later—rapid, effective analgesia, no return of PDPH. What this means for neuraxial choices in labor: https://t.co/DUTLrHH4oE #Anesthesia #Epidural #DPE #PDPH #MedTwitter #ObGyn https://t.co/7jRKETberN
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runa123's profile image
runa123☆OB Anesthesiologist in JAPAN @runa123
【⚠️硬膜外穿刺時の抵抗消失法（LOR）は生理食塩水で！】 ＃分娩時鎮痛 のための硬膜外穿刺💉（LORは空気）→偶発的硬膜穿破→クモ膜下カテーテル留置→無事終了しカテーテル抜去→#PDPH→硬膜外血液パッチ🩸×２（1回目は生食、2回目は空気）→体位によらない強い頭痛⚡️！→MRIで気脳症⬇️ ＃産科麻酔
_Anesthesiology's profile image
Anesthesiology Journals @_Anesthesiology
Images in #Anesthesiology - Air Entrainment and Subsequent Pneumocephalus Associated with Epidural Blood Patch 📷 https://t.co/hUYKes0EDs
_Anesthesiology's tweet photo. Images in #Anesthesiology - Air Entrainment and Subsequent Pneumocephalus Associated with Epidural Blood Patch 📷 https://t.co/hUYKes0EDs https://t.co/iOCEL0poZz
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anesthesianews's profile image
Anesthesiology News Verified account @anesthesianews
Dural puncture → EBP. 11 days later, labor DPE = rapid, effective, no PDPH return. Bottom line: Epidural/CSE/DPE remain options soon after EBP. https://t.co/DUTLrHH4oE #Anesthesia #MedTwitter #PDPH #Epidural #OBAnes #FOAMed #ObGyn
anesthesianews's tweet photo. Dural puncture → EBP. 11 days later, labor DPE = rapid, effective, no PDPH return. Bottom line: Epidural/CSE/DPE remain options soon after EBP. https://t.co/DUTLrHH4oE #Anesthesia #MedTwitter #PDPH #Epidural #OBAnes #FOAMed #ObGyn https://t.co/SrqPEBscdR
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KartikBSonawane's profile image
Dr.Kartik Sonawane Verified account @KartikBSonawane
🧠 PDPH: PUNCTURE, PERSISTENCE, or HEALING FAILURE? #PDPH #PostDuralPunctureHeadache #DuralPuncture #CSFLeak #EpiduralBloodPatch #HealingBiology #PatientSusceptibility #RegionalAnaesthesia #RegionalAnesthesia #GrayZonesInRA #GrayAreasInRA GRAY ZONES in RA: 🔸PDPH is familiar to every anesthesiologist. 🔸But it may not be only a puncture problem. 🔸It may also be a story of persistent CSF leak, delayed dural sealing, patient biology, diagnosis, and pathway-based care. 🟥 A. PUNCTURE STARTS THE STORY 🔸 Needle gauge matters 🔸 Needle tip design matters 🔸 Number of attempts matters 🔸 Accidental dural puncture matters 🔸 Operator experience matters 🔸 Technique remains important PDPH prevention begins with technique, but technique does not explain everything. 🟧 B. SAME PUNCTURE, DIFFERENT PATIENT 🔸 Some remain asymptomatic 🔸 Some develop mild headache 🔸 Some develop severe disability 🔸 Some recover quickly 🔸 Some have persistent symptoms 🔸 Some need EBP The puncture begins the syndrome, but patient response shapes the outcome. 🟨 C. PERSISTENCE DECIDES THE BURDEN 🔸 Dural rent may seal early 🔸 CSF leak may continue 🔸 Symptoms may persist 🔸 Disability may increase 🔸 Conservative treatment may fail 🔸 Escalation may be needed PDPH burden depends not only on the hole, but on why the hole remains open. 🟩 D. PATIENT BIOLOGY IS UNDEREXPLORED 🔸 Dural healing biology 🔸 Connective tissue characteristics 🔸 Headache phenotype 🔸 Pregnancy physiology 🔸 BMI 🔸 CSF pressure dynamics 🔸 Predictors of EBP failure 🔸 Risk of recurrence The patient may be as important as the puncture. 🟦 E. DIAGNOSIS NEEDS CAUTION 🔸 Orthostatic pattern matters 🔸 Timing matters 🔸 Severity matters 🔸 Associated symptoms matter 🔸 Differential diagnosis matters 🔸 Diagnostic anchoring should be avoided Diagnose PDPH early, but do not label every post-neuraxial headache as PDPH. 🟪 F. RED FLAGS MUST REOPEN THE DIAGNOSIS 🔸 Neurological deficit 🔸 Fever or meningism 🔸 Altered sensorium 🔸 Seizure 🔸 Severe hypertension 🔸 Non-postural headache 🔸 Worsening headache pattern 🔸 Poor response to usual care Red flags should never be hidden under the label of routine PDPH. 🟫 G. EBP REMAINS BEST ESTABLISHED 🔸 Uses autologous venous blood 🔸 Provides epidural tamponade 🔸 May seal the CSF leak 🔸 Often gives rapid relief 🔸 Timing matters 🔸 Repeat patch may be needed 🔸 Effective, but not perfect EBP is best-established, but not universally successful. ⬛ H. GOLD STANDARD DOES NOT MEAN PERFECT 🔸 Invasive procedure 🔸 Needs trained hands 🔸 Not universally practiced 🔸 May fail 🔸 Symptoms may recur 🔸 Long-term outcomes need clarity Gold standard means best-supported, not flawless. 🟥 I. ALTERNATIVES ARE BRIDGES, NOT EQUALS 🔸 Caffeine 🔸 Hydration 🔸 Analgesics 🔸 Sphenopalatine ganglion block 🔸 Greater occipital nerve block 🔸 Epidural saline 🔸 Cosyntropin 🔸 DISH10 maneuver Symptom relief is not always leak closure. 🟧 J. PATHWAY IS AS IMP AS PATCH 🔸 Early recognition 🔸 Patient counseling 🔸 Disability assessment 🔸 Red flag screening 🔸 Clear EBP criteria 🔸 Trained performer 🔸 Follow-up plan 🔸 Documentation and audit A gold-standard treatment needs a gold-standard pathway. 🎯 KEY TAKEAWAYS 🔹 The needle makes the hole 🔹 Patient biology decides the headache 🔹 Persistence decides the burden 🔹 Diagnosis needs caution 🔹 Red flags must be respected 🔹 EBP is best-established, not perfect 🔹 Alternatives are bridges, not equals 🔹 Pathway improves safety and consistency 🔥 PDPH PREVENTION begins with technique, PERSISTENCE may depend on biology, and TREATMENT needs evidence, training, and pathway. 🔥We have studied how the hole is made. Now we must study why the hole remains open.
KartikBSonawane's tweet photo. 🧠 PDPH: PUNCTURE, PERSISTENCE, or HEALING FAILURE? #PDPH #PostDuralPunctureHeadache #DuralPuncture #CSFLeak #EpiduralBloodPatch #HealingBiology #PatientSusceptibility #RegionalAnaesthesia #RegionalAnesthesia #GrayZonesInRA #GrayAreasInRA GRAY ZONES in RA: 🔸PDPH is familiar to every anesthesiologist. 🔸But it may not be only a puncture problem. 🔸It may also be a story of persistent CSF leak, delayed dural sealing, patient biology, diagnosis, and pathway-based care. 🟥 A. PUNCTURE STARTS THE STORY 🔸 Needle gauge matters 🔸 Needle tip design matters 🔸 Number of attempts matters 🔸 Accidental dural puncture matters 🔸 Operator experience matters 🔸 Technique remains important PDPH prevention begins with technique, but technique does not explain everything. 🟧 B. SAME PUNCTURE, DIFFERENT PATIENT 🔸 Some remain asymptomatic 🔸 Some develop mild headache 🔸 Some develop severe disability 🔸 Some recover quickly 🔸 Some have persistent symptoms 🔸 Some need EBP The puncture begins the syndrome, but patient response shapes the outcome. 🟨 C. PERSISTENCE DECIDES THE BURDEN 🔸 Dural rent may seal early 🔸 CSF leak may continue 🔸 Symptoms may persist 🔸 Disability may increase 🔸 Conservative treatment may fail 🔸 Escalation may be needed PDPH burden depends not only on the hole, but on why the hole remains open. 🟩 D. PATIENT BIOLOGY IS UNDEREXPLORED 🔸 Dural healing biology 🔸 Connective tissue characteristics 🔸 Headache phenotype 🔸 Pregnancy physiology 🔸 BMI 🔸 CSF pressure dynamics 🔸 Predictors of EBP failure 🔸 Risk of recurrence The patient may be as important as the puncture. 🟦 E. DIAGNOSIS NEEDS CAUTION 🔸 Orthostatic pattern matters 🔸 Timing matters 🔸 Severity matters 🔸 Associated symptoms matter 🔸 Differential diagnosis matters 🔸 Diagnostic anchoring should be avoided Diagnose PDPH early, but do not label every post-neuraxial headache as PDPH. 🟪 F. RED FLAGS MUST REOPEN THE DIAGNOSIS 🔸 Neurological deficit 🔸 Fever or meningism 🔸 Altered sensorium 🔸 Seizure 🔸 Severe hypertension 🔸 Non-postural headache 🔸 Worsening headache pattern 🔸 Poor response to usual care Red flags should never be hidden under the label of routine PDPH. 🟫 G. EBP REMAINS BEST ESTABLISHED 🔸 Uses autologous venous blood 🔸 Provides epidural tamponade 🔸 May seal the CSF leak 🔸 Often gives rapid relief 🔸 Timing matters 🔸 Repeat patch may be needed 🔸 Effective, but not perfect EBP is best-established, but not universally successful. ⬛ H. GOLD STANDARD DOES NOT MEAN PERFECT 🔸 Invasive procedure 🔸 Needs trained hands 🔸 Not universally practiced 🔸 May fail 🔸 Symptoms may recur 🔸 Long-term outcomes need clarity Gold standard means best-supported, not flawless. 🟥 I. ALTERNATIVES ARE BRIDGES, NOT EQUALS 🔸 Caffeine 🔸 Hydration 🔸 Analgesics 🔸 Sphenopalatine ganglion block 🔸 Greater occipital nerve block 🔸 Epidural saline 🔸 Cosyntropin 🔸 DISH10 maneuver Symptom relief is not always leak closure. 🟧 J. PATHWAY IS AS IMP AS PATCH 🔸 Early recognition 🔸 Patient counseling 🔸 Disability assessment 🔸 Red flag screening 🔸 Clear EBP criteria 🔸 Trained performer 🔸 Follow-up plan 🔸 Documentation and audit A gold-standard treatment needs a gold-standard pathway. 🎯 KEY TAKEAWAYS 🔹 The needle makes the hole 🔹 Patient biology decides the headache 🔹 Persistence decides the burden 🔹 Diagnosis needs caution 🔹 Red flags must be respected 🔹 EBP is best-established, not perfect 🔹 Alternatives are bridges, not equals 🔹 Pathway improves safety and consistency 🔥 PDPH PREVENTION begins with technique, PERSISTENCE may depend on biology, and TREATMENT needs evidence, training, and pathway. 🔥We have studied how the hole is made. Now we must study why the hole remains open.
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KartikBSonawane's profile image
Dr.Kartik Sonawane Verified account @KartikBSonawane
🩸 𝐄𝐏𝐈𝐃𝐔𝐑𝐀𝐋 𝐁𝐋𝐎𝐎𝐃 𝐏𝐀𝐓𝐂𝐇 (𝐄𝐁𝐏): 𝐏𝐫𝐞𝐜𝐢𝐬𝐢𝐨𝐧 𝐢𝐧 𝐍𝐞𝐮𝐫𝐚𝐱𝐢𝐚𝐥 𝐂𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 #EpiduralBloodPatch #RegionalAnesthesia #NeuraxialAnesthesia #PDPH #PatientSafety #AnesthesiaEducation #PainMedicine #EpiduralSafety #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: 1️⃣ ⚖️ 𝐓𝐑𝐀𝐍𝐒𝐅𝐎𝐑𝐌𝐈𝐍𝐆 𝐂𝐎𝐌𝐏𝐋𝐈𝐂𝐀𝐓𝐈𝐎𝐍 𝐈𝐍𝐓𝐎 𝐂𝐔𝐑𝐄 🔹 The EBP is far more than a simple treatment for PDPH. 🔹 It is one of the most critical interventions in RA, requiring meticulous attention to: • Timing • Blood source • Patient selection • Contraindications • Procedural expertise • Complication prevention 🔹 EBP acts as a highly effective biologic sealant that: • Restores CSF homeostasis • Seals dural defects • Rapidly reverses debilitating symptoms 🔹 Anatomy + physiology + vascular safety + timing + judgment = outcome 2️⃣ ⚠️ 𝐂𝐑𝐈𝐓𝐈𝐂𝐀𝐋 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐂𝐎𝐍𝐒𝐈𝐃𝐄𝐑𝐀𝐓𝐈𝐎𝐍𝐒 🔸 Optimal timing of intervention 🔸 Appropriate blood volume selection 🔸 Therapeutic vs prophylactic application 🔸 Management in anticoagulated patients 🔸 Infection and coagulopathy risks 🔸 Repeat patch decisions 🔸 Anatomical precision 🔸 Strict vascular source safety 3️⃣ 💉 𝐃𝐔𝐀𝐋 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌𝐒 𝐎𝐅 𝐄𝐁𝐏 🚀 𝐈𝐦𝐦𝐞𝐝𝐢𝐚𝐭𝐞 𝐄𝐟𝐟𝐞𝐜𝐭 (𝐏𝐫𝐞𝐬𝐬𝐮𝐫𝐞 𝐑𝐞𝐬𝐭𝐨𝐫𝐚𝐭𝐢𝐨𝐧) 🔹 Raises epidural pressure 🔹 Compresses thecal sac 🔹 Restores CSF equilibrium 🔹 Reduces meningeal traction 🔹 Relieves orthostatic headache rapidly 🛡️ 𝐃𝐞𝐟𝐢𝐧𝐢𝐭𝐢𝐯𝐞 𝐄𝐟𝐟𝐞𝐜𝐭 (𝐁𝐢𝐨𝐥𝐨𝐠𝐢𝐜 𝐒𝐞𝐚𝐥 𝐅𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧) 🔹 Forms fibrin clot over dural rent 🔹 Seals CSF leak 🔹 Prevents ongoing fluid loss 🔹 Promotes fibroblastic tissue healing 4️⃣ 🩸 𝐕𝐀𝐒𝐂𝐔𝐋𝐀𝐑 𝐒𝐎𝐔𝐑𝐂𝐄𝐒 𝐀. 🔵 𝐕𝐄𝐍𝐎𝐔𝐒 𝐁𝐋𝐎𝐎𝐃 (𝐆𝐎𝐋𝐃 𝐒𝐓𝐀𝐍𝐃𝐀𝐑𝐃) 🔸 𝐇𝐞𝐦𝐨𝐝𝐲𝐧𝐚𝐦𝐢𝐜 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞𝐬 🔹 Low pressure 🔹 Non-pulsatile flow 🔹 Controlled epidural spread 🔹 Predictable clot formation 🔸 𝐁𝐢𝐨𝐥𝐨𝐠𝐢𝐜𝐚𝐥 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞𝐬 🔹 Stable fibrin seal 🔹 Physiologic clotting behavior 🔹 Reduced endothelial trauma 🔹 Lower embolic potential 🔸 𝐏𝐫𝐚𝐜𝐭𝐢𝐜𝐚𝐥 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞𝐬 🔹 Easily accessible 🔹 Rapid bedside collection 🔹 Safer procedural profile 𝐁.🔴 𝐀𝐑𝐓𝐄𝐑𝐈𝐀𝐋 𝐁𝐋𝐎𝐎𝐃 (𝐀𝐕𝐎𝐈𝐃𝐄𝐃) 🫀 𝐇𝐞𝐦𝐨𝐝𝐲𝐧𝐚𝐦𝐢𝐜 𝐃𝐚𝐧𝐠𝐞𝐫𝐬 🔺 High-pressure system 🔺 Pulsatile flow 🔺 Forceful epidural spread 🔺 Tissue dissection risk 🔺 Sudden spinal cord compression potential ⚠️ 𝐌𝐚𝐣𝐨𝐫 𝐑𝐢𝐬𝐤𝐬 🔴 Epidural hematoma 🔴 Cord ischemia 🔴 Vasospasm 🔴 Nerve root injury 🔴 Pseudoaneurysm 🔴 Neurological deficit 🔴 Paralysis 🧬 𝐖𝐡𝐲 𝐀𝐫𝐭𝐞𝐫𝐢𝐚𝐥 𝐁𝐥𝐨𝐨𝐝 𝐈𝐬 𝐃𝐚𝐧𝐠𝐞𝐫𝐨𝐮𝐬 🔺 Unpredictable clot dynamics 🔺 Greater pressure-related trauma 🔺 Increased vascular injury 🔺 Higher catastrophic complication potential 5️⃣ 🕒 𝐓𝐈𝐌𝐈𝐍𝐆: 𝐀 𝐌𝐀𝐉𝐎𝐑 𝐃𝐄𝐓𝐄𝐑𝐌𝐈𝐍𝐀𝐍𝐓 𝐎𝐅 𝐒𝐔𝐂𝐂𝐄𝐒𝐒 𝐄𝐚𝐫𝐥𝐲 𝐄𝐁𝐏 (<𝟐𝟒 𝐡𝐨𝐮𝐫𝐬) 🔹 Faster relief in severe cases 🔸 Higher failure rates 🔸 Active CSF leakage may disrupt clot 𝐃𝐞𝐥𝐚𝐲𝐞𝐝 𝐄𝐁𝐏 (𝟐𝟒–𝟒𝟖 𝐡𝐨𝐮𝐫𝐬) 🔹 Better clot stabilization 🔹 Higher long-term efficacy 🔹 Reduced repeat procedure need 6️⃣ 📚 𝐄𝐁𝐏 - 𝐀𝐧 𝐀𝐃𝐕𝐀𝐍𝐂𝐄𝐃 𝐍𝐄𝐔𝐑𝐀𝐗𝐈𝐀𝐋 𝐏𝐑𝐀𝐂𝐓𝐈𝐂𝐄 𝐄𝐁𝐏 𝐢𝐧𝐭𝐞𝐠𝐫𝐚𝐭𝐞𝐬: 🔹 Detailed neuraxial anatomy 🔹 CSF physiology 🔹 Hemodynamic principles 🔹 Clot biology 🔹 Infection prevention 🔹 Procedural precision 🔹 Risk-benefit judgment 🎯 𝐅𝐈𝐍𝐀𝐋 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🏆 🩸 Right Blood (Venous) 📍 Right Space (Epidural) ⏱️ Right Timing (Clinical Judgment) 🔥 EBP represents one of regional anesthesia’s true 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒, where science, skill, & clinical judgment must align to safely transform 𝐂𝐎𝐌𝐏𝐋𝐈𝐂𝐀𝐓𝐈𝐎𝐍 𝐢𝐧𝐭𝐨 𝐂𝐔𝐑𝐄.
KartikBSonawane's tweet photo. 🩸 𝐄𝐏𝐈𝐃𝐔𝐑𝐀𝐋 𝐁𝐋𝐎𝐎𝐃 𝐏𝐀𝐓𝐂𝐇 (𝐄𝐁𝐏): 𝐏𝐫𝐞𝐜𝐢𝐬𝐢𝐨𝐧 𝐢𝐧 𝐍𝐞𝐮𝐫𝐚𝐱𝐢𝐚𝐥 𝐂𝐨𝐦𝐩𝐥𝐢𝐜𝐚𝐭𝐢𝐨𝐧 𝐌𝐚𝐧𝐚𝐠𝐞𝐦𝐞𝐧𝐭 #EpiduralBloodPatch #RegionalAnesthesia #NeuraxialAnesthesia #PDPH #PatientSafety #AnesthesiaEducation #PainMedicine #EpiduralSafety #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: 1️⃣ ⚖️ 𝐓𝐑𝐀𝐍𝐒𝐅𝐎𝐑𝐌𝐈𝐍𝐆 𝐂𝐎𝐌𝐏𝐋𝐈𝐂𝐀𝐓𝐈𝐎𝐍 𝐈𝐍𝐓𝐎 𝐂𝐔𝐑𝐄 🔹 The EBP is far more than a simple treatment for PDPH. 🔹 It is one of the most critical interventions in RA, requiring meticulous attention to: • Timing • Blood source • Patient selection • Contraindications • Procedural expertise • Complication prevention 🔹 EBP acts as a highly effective biologic sealant that: • Restores CSF homeostasis • Seals dural defects • Rapidly reverses debilitating symptoms 🔹 Anatomy + physiology + vascular safety + timing + judgment = outcome 2️⃣ ⚠️ 𝐂𝐑𝐈𝐓𝐈𝐂𝐀𝐋 𝐂𝐋𝐈𝐍𝐈𝐂𝐀𝐋 𝐂𝐎𝐍𝐒𝐈𝐃𝐄𝐑𝐀𝐓𝐈𝐎𝐍𝐒 🔸 Optimal timing of intervention 🔸 Appropriate blood volume selection 🔸 Therapeutic vs prophylactic application 🔸 Management in anticoagulated patients 🔸 Infection and coagulopathy risks 🔸 Repeat patch decisions 🔸 Anatomical precision 🔸 Strict vascular source safety 3️⃣ 💉 𝐃𝐔𝐀𝐋 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌𝐒 𝐎𝐅 𝐄𝐁𝐏 🚀 𝐈𝐦𝐦𝐞𝐝𝐢𝐚𝐭𝐞 𝐄𝐟𝐟𝐞𝐜𝐭 (𝐏𝐫𝐞𝐬𝐬𝐮𝐫𝐞 𝐑𝐞𝐬𝐭𝐨𝐫𝐚𝐭𝐢𝐨𝐧) 🔹 Raises epidural pressure 🔹 Compresses thecal sac 🔹 Restores CSF equilibrium 🔹 Reduces meningeal traction 🔹 Relieves orthostatic headache rapidly 🛡️ 𝐃𝐞𝐟𝐢𝐧𝐢𝐭𝐢𝐯𝐞 𝐄𝐟𝐟𝐞𝐜𝐭 (𝐁𝐢𝐨𝐥𝐨𝐠𝐢𝐜 𝐒𝐞𝐚𝐥 𝐅𝐨𝐫𝐦𝐚𝐭𝐢𝐨𝐧) 🔹 Forms fibrin clot over dural rent 🔹 Seals CSF leak 🔹 Prevents ongoing fluid loss 🔹 Promotes fibroblastic tissue healing 4️⃣ 🩸 𝐕𝐀𝐒𝐂𝐔𝐋𝐀𝐑 𝐒𝐎𝐔𝐑𝐂𝐄𝐒 𝐀. 🔵 𝐕𝐄𝐍𝐎𝐔𝐒 𝐁𝐋𝐎𝐎𝐃 (𝐆𝐎𝐋𝐃 𝐒𝐓𝐀𝐍𝐃𝐀𝐑𝐃) 🔸 𝐇𝐞𝐦𝐨𝐝𝐲𝐧𝐚𝐦𝐢𝐜 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞𝐬 🔹 Low pressure 🔹 Non-pulsatile flow 🔹 Controlled epidural spread 🔹 Predictable clot formation 🔸 𝐁𝐢𝐨𝐥𝐨𝐠𝐢𝐜𝐚𝐥 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞𝐬 🔹 Stable fibrin seal 🔹 Physiologic clotting behavior 🔹 Reduced endothelial trauma 🔹 Lower embolic potential 🔸 𝐏𝐫𝐚𝐜𝐭𝐢𝐜𝐚𝐥 𝐀𝐝𝐯𝐚𝐧𝐭𝐚𝐠𝐞𝐬 🔹 Easily accessible 🔹 Rapid bedside collection 🔹 Safer procedural profile 𝐁.🔴 𝐀𝐑𝐓𝐄𝐑𝐈𝐀𝐋 𝐁𝐋𝐎𝐎𝐃 (𝐀𝐕𝐎𝐈𝐃𝐄𝐃) 🫀 𝐇𝐞𝐦𝐨𝐝𝐲𝐧𝐚𝐦𝐢𝐜 𝐃𝐚𝐧𝐠𝐞𝐫𝐬 🔺 High-pressure system 🔺 Pulsatile flow 🔺 Forceful epidural spread 🔺 Tissue dissection risk 🔺 Sudden spinal cord compression potential ⚠️ 𝐌𝐚𝐣𝐨𝐫 𝐑𝐢𝐬𝐤𝐬 🔴 Epidural hematoma 🔴 Cord ischemia 🔴 Vasospasm 🔴 Nerve root injury 🔴 Pseudoaneurysm 🔴 Neurological deficit 🔴 Paralysis 🧬 𝐖𝐡𝐲 𝐀𝐫𝐭𝐞𝐫𝐢𝐚𝐥 𝐁𝐥𝐨𝐨𝐝 𝐈𝐬 𝐃𝐚𝐧𝐠𝐞𝐫𝐨𝐮𝐬 🔺 Unpredictable clot dynamics 🔺 Greater pressure-related trauma 🔺 Increased vascular injury 🔺 Higher catastrophic complication potential 5️⃣ 🕒 𝐓𝐈𝐌𝐈𝐍𝐆: 𝐀 𝐌𝐀𝐉𝐎𝐑 𝐃𝐄𝐓𝐄𝐑𝐌𝐈𝐍𝐀𝐍𝐓 𝐎𝐅 𝐒𝐔𝐂𝐂𝐄𝐒𝐒 𝐄𝐚𝐫𝐥𝐲 𝐄𝐁𝐏 (<𝟐𝟒 𝐡𝐨𝐮𝐫𝐬) 🔹 Faster relief in severe cases 🔸 Higher failure rates 🔸 Active CSF leakage may disrupt clot 𝐃𝐞𝐥𝐚𝐲𝐞𝐝 𝐄𝐁𝐏 (𝟐𝟒–𝟒𝟖 𝐡𝐨𝐮𝐫𝐬) 🔹 Better clot stabilization 🔹 Higher long-term efficacy 🔹 Reduced repeat procedure need 6️⃣ 📚 𝐄𝐁𝐏 - 𝐀𝐧 𝐀𝐃𝐕𝐀𝐍𝐂𝐄𝐃 𝐍𝐄𝐔𝐑𝐀𝐗𝐈𝐀𝐋 𝐏𝐑𝐀𝐂𝐓𝐈𝐂𝐄 𝐄𝐁𝐏 𝐢𝐧𝐭𝐞𝐠𝐫𝐚𝐭𝐞𝐬: 🔹 Detailed neuraxial anatomy 🔹 CSF physiology 🔹 Hemodynamic principles 🔹 Clot biology 🔹 Infection prevention 🔹 Procedural precision 🔹 Risk-benefit judgment 🎯 𝐅𝐈𝐍𝐀𝐋 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🏆 🩸 Right Blood (Venous) 📍 Right Space (Epidural) ⏱️ Right Timing (Clinical Judgment) 🔥 EBP represents one of regional anesthesia’s true 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒, where science, skill, & clinical judgment must align to safely transform 𝐂𝐎𝐌𝐏𝐋𝐈𝐂𝐀𝐓𝐈𝐎𝐍 𝐢𝐧𝐭𝐨 𝐂𝐔𝐑𝐄.
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BJAJournals's profile image
British Journal of Anaesthesia @BJAJournals
How should #PDPH be managed after accidental dural puncture (#ADP)? Dziadzko et al. respond to recent correspondence, exploring new evidence and the challenges of heterogeneity in practice. Read their insights: https://t.co/fUgRB0fJ14 #Anaesthesia #PeriOpMed
BJAJournals's tweet photo. How should #PDPH be managed after accidental dural puncture (#ADP)? Dziadzko et al. respond to recent correspondence, exploring new evidence and the challenges of heterogeneity in practice. Read their insights: https://t.co/fUgRB0fJ14 #Anaesthesia #PeriOpMed https://t.co/42fMjKd2xL
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KerenLeah's profile image
Keren Leah @KerenLeah
🧠 Brain MRI in PDPH 🧠 118 PDPH patients, and 92% had NO intracranial hypotension findings on brain MRI. Not the paper's main focus, but a really important detail. #PDPH #spinalCSFleak #Anes #Anaes #CSFleak
PeterGKranz's profile image
Peter Kranz @PeterGKranz
🚨New Paper Alert! 🚨 When should myelography play a role in PDPH evaluation? How do we avoid repeat dural punctures? How often does it help? @issclsociety @TheAJNR @The_ASSR @spinalCSFleak @SpinalCSFCanada https://t.co/QCs2zhWFgX
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Shiero Kawano @K_SHIERO_0225
ラリージャパン 2025 Day2終了！ 走行距離417.9km いろいろあってもうDay3始まっとるやん笑 勝田貴元選手の優勝もあり得る！ 頑張ってください！ 寝ます！ #ラリージャパン2025 #WRC #勝田貴元　#Ford #GRヤリスrally2 #ラリー2 #rally2 #PdPh #TGR
K_SHIERO_0225's tweet photo. ラリージャパン 2025 Day2終了！ 走行距離417.9km いろいろあってもうDay3始まっとるやん笑 勝田貴元選手の優勝もあり得る！ 頑張ってください！ 寝ます！ #ラリージャパン2025 #WRC #勝田貴元　#Ford #GRヤリスrally2 #ラリー2 #rally2 #PdPh #TGR https://t.co/9dW44Kth68
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runa123's profile image
runa123☆OB Anesthesiologist in JAPAN @runa123
産科患者における硬膜穿刺後頭痛（PDPH）後の慢性疼痛および長期的障害：症例対照コホートの5年間の前向き追跡調査 1⃣PDPHは5年後も慢性頭痛・腰痛として持続することが多い 2⃣EBPの有無にかかわらず高い機能障害率 3⃣PDPHは長期的なフォローと予防が必要 ＃PDPH ＃OBAnes https://t.co/EDRhUzDfw8
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Ropivacaine's profile image
Dr. Vishal Uppal MBBS, FRCA 🇨🇦🇮🇳🏴󠁧󠁢󠁳󠁣󠁴󠁿 @Ropivacaine
@DebeshBhoi @aiims_newdelhi @KalagaraHari @ESRA_Society @ASRA_Society Thank you @DebeshBhoi 🙏 It was a privilege to be at @aiims_newdelhi, an institution with an outstanding reputation. Truly impressed by the warm hospitality of Prof. Gangaprasad, Anjolie, &amp; the enthusiastic team. I thoroughly enjoyed the interactive discussions on #PDPH
Ropivacaine's tweet photo. @DebeshBhoi @aiims_newdelhi @KalagaraHari @ESRA_Society @ASRA_Society Thank you @DebeshBhoi 🙏 It was a privilege to be at @aiims_newdelhi, an institution with an outstanding reputation. Truly impressed by the warm hospitality of Prof. Gangaprasad, Anjolie, &amp; the enthusiastic team. I thoroughly enjoyed the interactive discussions on #PDPH https://t.co/hsmwOwSXBI
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DebeshBhoi's profile image
Professor Dr Debesh Bhoi,MBBS,MD,MNAMS, @DebeshBhoi
Nice to have the talk on #PDPH.. at AIIMS,New Delhi Thanks Prof Vishal Uppal..a great interactive talk..@aiims_newdelhi @Ropivacaine @KalagaraHari @ESRA_Society @ASRA_Society
DebeshBhoi's tweet photo. Nice to have the talk on #PDPH.. at AIIMS,New Delhi Thanks Prof Vishal Uppal..a great interactive talk..@aiims_newdelhi @Ropivacaine @KalagaraHari @ESRA_Society @ASRA_Society https://t.co/lAvsbYzT6q
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Charlotte Zander @ZanderCharlotte
Chronic post-dural puncture headache exists! However, MRI in these patients is mostly negative, contrary to the tremendous symptom burden. Read the full article here ⬇️ Big thanks to @Niklas_Luetzen and the whole #CSF Team at Universitätsklinikum Freiburg! #PDPH @issclsociety
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Headache Journal @HeadacheJournal
Open Access: An MRI study using the Bern score finds that patients with chronic post-dural puncture #headache do not have typical imaging features of #intracranial #hypotension https://t.co/BHghPObrt4 @ZanderCharlotte et al
HeadacheJournal's tweet photo. Open Access: An MRI study using the Bern score finds that patients with chronic post-dural puncture #headache do not have typical imaging features of #intracranial #hypotension https://t.co/BHghPObrt4 @ZanderCharlotte et al https://t.co/t9XFJUurw5
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⭐️茨城★筑西市⭐️しのはら克子 @cha_cha_db
画像診断だけでは #脳脊髄液漏出症 は見逃される 【翻訳】 研究結果は、現在のMRI診断が慢性PDPH患者を検出する信頼性が低いことを強調していますが、これが診断の軽視や治療の拒否につながってはなりません。 #cPDPH #PDPH #Anaes #Anes #OBAnes
KerenLeah's profile image
Keren Leah @KerenLeah
❗️'Our findings highlight the unreliability of current MRI diagnostics to detect patients with chronic PDPH, which must not lead to a mitigation of the diagnosis or a refusal of treatment.' 👏 #cPDPH #PDPH #Anaes #Anes #OBAnes
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KerenLeah's profile image
Keren Leah @KerenLeah
❗️'Our findings highlight the unreliability of current MRI diagnostics to detect patients with chronic PDPH, which must not lead to a mitigation of the diagnosis or a refusal of treatment.' 👏 #cPDPH #PDPH #Anaes #Anes #OBAnes
HeadacheJournal's profile image
Headache Journal @HeadacheJournal
Open Access: An MRI study using the Bern score finds that patients with chronic post-dural puncture #headache do not have typical imaging features of #intracranial #hypotension https://t.co/BHghPObrt4 @ZanderCharlotte et al
HeadacheJournal's tweet photo. Open Access: An MRI study using the Bern score finds that patients with chronic post-dural puncture #headache do not have typical imaging features of #intracranial #hypotension https://t.co/BHghPObrt4 @ZanderCharlotte et al https://t.co/t9XFJUurw5
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CJA_Journal's profile image
CJA - Canadian Journal of Anesthesia @CJA_Journal
Continuing Professional Development Postdural puncture headache in obstetrics - Canadian Journal of Anesthesia #CJA #CJA2025 #Anesthesia #Anesthesiology https://t.co/KkTWywot4w #ProfessionalDevelopment #OBAnes #PDPH
CJA_Journal's tweet photo. Continuing Professional Development Postdural puncture headache in obstetrics - Canadian Journal of Anesthesia #CJA #CJA2025 #Anesthesia #Anesthesiology https://t.co/KkTWywot4w #ProfessionalDevelopment #OBAnes #PDPH https://t.co/MMTsJozL8B
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CJA_Journal's profile image
CJA - Canadian Journal of Anesthesia @CJA_Journal
Continuing Professional Development Postdural puncture headache in obstetrics - Canadian Journal of Anesthesia #Anesthesia #Anesthesiology https://t.co/238Gv065QR #CPD #ProfessionalDevelopment #OBAnes #PDPH
CJA_Journal's tweet photo. Continuing Professional Development Postdural puncture headache in obstetrics - Canadian Journal of Anesthesia #Anesthesia #Anesthesiology https://t.co/238Gv065QR #CPD #ProfessionalDevelopment #OBAnes #PDPH https://t.co/qOTN8lUozi
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michelleobanes's profile image
Michelle Simon @michelleobanes
What a great pro-con recreation!! At the #ColAnest2025 #WCOA2025 @FeycePeralta @CarloPancaro #pdph
michelleobanes's tweet photo. What a great pro-con recreation!! At the #ColAnest2025 #WCOA2025 @FeycePeralta @CarloPancaro #pdph https://t.co/3a6N1Kygs3
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CJA_Journal's profile image
CJA - Canadian Journal of Anesthesia @CJA_Journal
Continuing Professional Development Postdural puncture headache in obstetrics - Canadian Journal of Anesthesia #CJA2025 #Anesthesia #Anesthesiology https://t.co/bRUZdWGClR #CPD #ProfessionalDevelopment #OBAnes #PDPH
CJA_Journal's tweet photo. Continuing Professional Development Postdural puncture headache in obstetrics - Canadian Journal of Anesthesia #CJA2025 #Anesthesia #Anesthesiology https://t.co/bRUZdWGClR #CPD #ProfessionalDevelopment #OBAnes #PDPH https://t.co/y2988P1EWn
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KerenLeah's profile image
Keren Leah @KerenLeah
❗️And brain MRI can be normal, too 🧠 The thought of a child enduring these pain levels 💔 #PDPH #Anes #Anaes #cPDPH #pPDPH
spinacademics's profile image
SPIN | Society of Pediatric Neuroimaging @spinacademics
This week’s SPIN-POV: Post-LP CSF leaks are not uncommon in children. This child presented with a severe headache and MRI features of intracranial hypotension and was treated with targeted epidural blood patching. Using atraumatic pencil-point needles can reduce the risk.
spinacademics's tweet photo. This week’s SPIN-POV: Post-LP CSF leaks are not uncommon in children. This child presented with a severe headache and MRI features of intracranial hypotension and was treated with targeted epidural blood patching. Using atraumatic pencil-point needles can reduce the risk. https://t.co/shzSm5H4Ju
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