Role of Cosyntropin in the Management of Postpartum Postdural Puncture Headache: A Two-center Retrospective Cohort Study

( Int J Obstet Anesth . 2023;56:103917. doi: 10.1016/j.ijoa.2023.103917) Approximately half a million women in the UK and up to two million in the USA receive labor neuraxial analgesia annually, with 0.5% to 1.5% experiencing unintentional dural puncture (UDP), leading to postdural puncture headache (PDPH) in 70% of cases. An epidural blood patch (EBP) is often necessary when conservative measures fail. Research suggests that prophylactic and therapeutic use of an adrenocorticotropic hormone analog, cosyntropin, may reduce PDPH incidence with the theoretical basis for its efficacy lying in its modulation of pain pathways, resembling morphine-like properties, and potential influence on cerebrospinal fluid dynamics. However, studies in this area are limited and contradictory.