Post-Dural Puncture Headache: A Case Report

The purpose of the study is to present a complicated case who present an unwanted severe headache which occur in a patient receiving a spinal or epidural injection. We report the case of a 64-year-old male patient who underwent skin transplantation, namely split-thickness skin graft (STSG) on the right instep using a 26 G Quincke spinal needle. After successful plastic surgery which lasts 90 minutes using spinal anesthesia, postoperatively, the patient was admitted to the recovery room and instructed to rest in bed for 12 hours, and also not to sit and lift the head. After the motoric strength of both legs is normal (Bromage scale 0) the patient may tilt left-right, given RL infusion 30 tpm, and ketorolac analgesic injection 30 mg IV. In the recovery room the patient allowed to drink and eat as usual. But just after four hours, the patient goes to the bathroom to urinate, and at that moment the patient felt a sudden severe headache. The patient had to be helped by his family to get back to bed and lie down and after 15 minutes, the complaints subsided. The doctor on duty who was reported by the nurse about this incident asked the patient to rest in bed for 24 hours until the complaint completely disappears. In the following day, the patient discharged from the hospital in good condition. Despite its frequency and impact, PDPH remains poorly understood, and further research is needed to elucidate its actual scope of the problem, its pathophysiology and optimal management.