Anestesia e Pesquisa Clínica
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Use of Cosyntropin for Treatment of Refractory Post Dural Puncture Headache (PDPH): Case Report and a Suggested Algorithm

Andaleeb Abrar Ahmed, Sanjib Adhikary, Thomas A.Verbeek and Sonia Vaida

Postdural Puncture Headache (PDPH) is a frequent complication of neuraxial blockade. Use of ACTH or its synthetic analogs for the treatment of PDPH has been reported in the literature since 1994. We describe a case of refractory PDPH in a 36 year old female despite two epidural blood patches (EBPs). Evidence-based algorithmic management of PDPH has never been reported in Anesthesiology literature. Based on the available evidence we developed an opinion-based algorithm for management of PDPH. The associated case report highlights the role of ACTH and the importance of algorithmic management of PDPH.