Cosyntropin 500 mcg in 1000cc Normal Saline

Epidural Blood Patch and I000cc Normal Saline

Cosyntropin 500 mcg in 1000cc Normal Saline
Cosyntropin: Intravenous Drug Infusion over 1 hour and a half

Intravenous Cosyntropin Group A

Epidural Blood Patch and I000cc Normal Saline
Epidural Blood Patch: Blood drawn from subject and then same Blood placed into Epidural space by anesthesia personnel.

Epidural Blood Patch Group B

Total

Sex: Female, Male

Pain was measured 1-10 scale with 10 representing the highest level of pain, number reported was the mean

Pain

self-reported function scores were 1-10 with 10 representing the greatest impairment to function

Function

measure to obtain headache history was considered positive if the patient reported any previous diagnosis of recurrent headaches or previous post dural headache

Positional Headache

measure describes number of patients who reported positive for nausea/vomiting

Nausea/Vomiting

measure describes number of patients who reported positive for neck stiffness

Neck Stiffness

Numerical 0-10 (0 no pain, 10 worst pain)

Headache Pain Score

Functional score 0-10 (0 being able to function all tasks of daily living, 10 not able to complete activities of daily living (ADLs)

Functioning Score

Functional score 0-10 (0 being able to function all tasks of daily living, 10 not able to complete ADLs

Overall Study

Steven Hanling, MD

Postdural Puncture Headache

Intravenous Drug Infusion over 1 hour and a half

Cosyntropin

Blood drawn from subject and then same Blood placed into Epidural space by anesthesia personnel.

Epidural Blood Patch

Cosyntropin Versus Epidural Blood Patch (EBP) for Treatment of Treatment of Post Dural Puncture Headache

Cosyntropin Versus Epidural Blood Patch (EBP) for Treatment of Treatment of Post Dural Puncture Headache (PDPH)

United States Naval Medical Center, San Diego

United States Naval Medical Center, Portsmouth

Ephedrine 10mg iv once at time of combined spinal epidural insertion

1ml normal saline intravenously once at time of combined spinal epidural insertion

Ephedrine 10mg iv once at time of combined spinal epidural insertion
Ephedrine: Patients received additional doses of ephedrine 10mg IV to a maximum of 30mg if BP remained low (<90mmHg systolic) and/was associated with persistent fetal bradycardia or maternal symptoms of dizziness and nausea

Prophylactic Ephedrine

1ml normal saline intravenously once at time of combined spinal epidural insertion
Placebo

Normal Saline Control Group

Incidence of early profound fetal bradycardia

Early Profound Fetal Bradycardia

Incidence of Tetanic (sustained) Uterine Contraction (TUC)

Tetanic (Sustained) Uterine Contraction (TUC)

Urgent Cesarean Delivery

Dr. David R. Gambling

Labor Pain

Patients received additional doses of ephedrine 10mg IV to a maximum of 30mg if BP remained low (<90mmHg systolic) and/was associated with persistent fetal bradycardia or maternal symptoms of dizziness and nausea

Ephedrine

Patients received normal saline (placebo) administered immediately after combined spinal epidural (CSE) placement

post-dural puncture headache/crise epiléptica

Cosyntropin Versus Epidural Blood Patch (EBP) for Treatment of Treatment of Post Dural Puncture Headache

Prophylactic Ephedrine and Combined Spinal Epidurals for Labor

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