Continuous epidural saline infusion combined with intranasal dexmedetomidine for severe post-dural puncture headache with intracranial hypotension: a case report
- 1Department of Anesthesiology, Shunde Women and Children’s Hospital of Guangdong Medical University, Foshan, Guangdong, China
- 2Department of Anesthesiology, Guangzhou University of Traditional Chinese Medicine ShunDe Traditional Chinese Medicine Hospital, Foshan, Guangdong, China
Abstract
BackgroundPost-dural puncture headache (PDPH) is a common complication of obstetric neuraxial anesthesia. Epidural blood patch (EBP) is the standard treatment for moderate-to-severe PDPH, but it may be deferred or relatively contraindicated when systemic infection is suspected. Current evidence on alternative treatments for PDPH has mainly focused on single interventions, and reports describing combined therapeutic strategies remain limited.Case presentationA 37-year-old parturient developed accidental dural puncture during epidural labor analgesia and subsequently experienced severe PDPH 2 h after delivery, with a sitting numerical rating scale (NRS) score of 10. Cranial magnetic resonance imaging (MRI) showed features consistent with intracranial hypotension, including narrowing of the suprasellar cistern and inferior displacement of the cerebellar tonsils. Because high fever (39.2 °C) and leukocytosis raised concern for possible systemic infection, EBP was considered high risk. Continuous epidural normal saline infusion was administered through the retained epidural catheter at 10 mL/h, together with empirical ceftriaxone, non-steroidal analgesia, bed rest, and fluid support. Intranasal dexmedetomidine 50 μg per dose twice daily was added at approximately 24 h postpartum because of persistent headache. Within 48 h, the patient's headache improved in a stepwise manner: the sitting NRS score was 10 at 24 h postpartum, 4 at 36 h postpartum, and 0 at 48 h postpartum. Follow-up MRI on postpartum day 5 showed marked improvement in the signs of intracranial hypotension. No recurrence occurred at 1- and 3-month follow-up.ConclusionIn selected patients with severe PDPH for whom EBP is unsuitable or high risk, continuous epidural saline infusion combined with intranasal dexmedetomidine may be a feasible non-blood-patch alternative, although causality cannot be established from a single case because of concurrent interventions and possible spontaneous improvement. Larger studies are required to evaluate safety, efficacy, and optimal dosing.
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BibTeX
@article{li2026continuous,
title = {{Continuous epidural saline infusion combined with intranasal dexmedetomidine for severe post-dural puncture headache with intracranial hypotension: a case report}},
author = {Yinghong Li and Qingle Kang and Huiyan Liang and Haiyan Zhang and Shengjie Chen and Xiangyi Lin and Haobin Peng},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1929098},
url = {https://doi.org/10.3389/fmed.2026.1929098},
note = {CC BY},
}
RIS
TY - JOUR
TI - Continuous epidural saline infusion combined with intranasal dexmedetomidine for severe post-dural puncture headache with intracranial hypotension: a case report
AU - Yinghong Li
AU - Qingle Kang
AU - Huiyan Liang
AU - Haiyan Zhang
AU - Shengjie Chen
AU - Xiangyi Lin
AU - Haobin Peng
PY - 2026
DA - 2026/10/26
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1929098
UR - https://doi.org/10.3389/fmed.2026.1929098
AB - BackgroundPost-dural puncture headache (PDPH) is a common complication of obstetric neuraxial anesthesia. Epidural blood patch (EBP) is the standard treatment for moderate-to-severe PDPH, but it may be deferred or relatively contraindicated when systemic infection is suspected. Current evidence on alternative treatments for PDPH has mainly focused on single interventions, and reports describing combined therapeutic strategies remain limited.Case presentationA 37-year-old parturient developed accidental dural puncture during epidural labor analgesia and subsequently experienced severe PDPH 2 h after delivery, with a sitting numerical rating scale (NRS) score of 10. Cranial magnetic resonance imaging (MRI) showed features consistent with intracranial hypotension, including narrowing of the suprasellar cistern and inferior displacement of the cerebellar tonsils. Because high fever (39.2 °C) and leukocytosis raised concern for possible systemic infection, EBP was considered high risk. Continuous epidural normal saline infusion was administered through the retained epidural catheter at 10 mL/h, together with empirical ceftriaxone, non-steroidal analgesia, bed rest, and fluid support. Intranasal dexmedetomidine 50 μg per dose twice daily was added at approximately 24 h postpartum because of persistent headache. Within 48 h, the patient's headache improved in a stepwise manner: the sitting NRS score was 10 at 24 h postpartum, 4 at 36 h postpartum, and 0 at 48 h postpartum. Follow-up MRI on postpartum day 5 showed marked improvement in the signs of intracranial hypotension. No recurrence occurred at 1- and 3-month follow-up.ConclusionIn selected patients with severe PDPH for whom EBP is unsuitable or high risk, continuous epidural saline infusion combined with intranasal dexmedetomidine may be a feasible non-blood-patch alternative, although causality cannot be established from a single case because of concurrent interventions and possible spontaneous improvement. Larger studies are required to evaluate safety, efficacy, and optimal dosing.
SN - 2296-858X
ER -