Bedside Sedation for the Prevention of Post Dural Puncture Headache
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|ClinicalTrials.gov Identifier: NCT01503788|
Recruitment Status : Unknown
Verified January 2012 by Tel-Aviv Sourasky Medical Center.
Recruitment status was: Not yet recruiting
First Posted : January 4, 2012
Last Update Posted : January 4, 2012
Dural or lumbar puncture (LP), the passing of a needle into the space of the spinal cord, is a common procedure in everyday clinical practice. The most common use for LP is to measure the spinal fluid pressure and sample spinal fluid for laboratory analysis. However, it is also used for therapeutic purposes, such as administering chemotherapy or spinal anesthesia.
A notorious side effect of dural puncture is headache that ranges from mild to debilitating and may last for several days following the procedure. Among diagnosed patients, 39% experience at least 1 week of impaired ability to perform activities of daily living. The likelihood of developing a headache after dural puncture depends on a number of factors. As fluid leak is assumed to be the culprit mechanism in this headache strategies to minimize the leak seem to offer the best path to lowering the incidence of headache after diagnostic LP, the commonest clinical context of dural puncture in medical practice.
Lumbar puncture is a highly stressful event for most patients. As both pain and anxiety cause adrenergic stimulation, they also cause an increase in ICP. We believe that this mild increase in ICP, occurring before the puncture as well as during the puncture itself may exacerbate the pressure difference between the CSF space and the epidural space and so worsen the CSF leak Furthermore, this excess pressure, although mild, might cause the dural puncture hole to widen slightly and so further augment the leak and possibly even prolong it. Furthermore, the very anticipation of pain causes a rise in neurotransmitters that may cause a sensitization effect and worsen pain. This increase in adrenergic drive as well as the sensitization to pain can be effectively blunted by the periprocedural use of mild IV sedation. Benzodiazepines, with their sedative-hypnotic qualities are well suited for this task.
This study aims to test the effect of mild peri-procedural IV sedation using Midazolam on the rates of headache after diagnostic LP.
Patients undergoing a diagnostic LP will be randomized into two groups. Group 1 will undergo the procedure as routinely practiced. Group 2 will be given Midazolam IV 10-5 minutes prior to the procedure and undergo the same diagnostic procedure. All patients in the study will remain under observation in the hospital for at least 6 hours.
Patients will be evaluated for headache and specifically for headache. Clinical follow up will continue for 72 hours by administering a short questionnaire over the telephone.
|Condition or disease||Intervention/treatment||Phase|
|Post Dural Puncture Headache||Drug: Midazolam||Phase 2|
|Study Type :||Interventional (Clinical Trial)|
|Estimated Enrollment :||100 participants|
|Intervention Model:||Parallel Assignment|
|Official Title:||Periprocedural Sedation for the Prevention of Post Dural Puncture Headache|
|Study Start Date :||February 2012|
|Estimated Primary Completion Date :||February 2014|
|Estimated Study Completion Date :||February 2014|
Active Comparator: periprocedural sedation with midazolam
periprocedural sedation with IV midazolam 5-10 minutes before diagnostic lumbar puncture
participants will be given Midazolam IV 10-5 minutes prior to diagnostic lumbar puncture
No Intervention: No intervention
Participants will undergo the diagnostic lumbar puncture as routinely practiced
- rate of post dural puncture headache [ Time Frame: 72 hours ]
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01503788
|Contact: Haggai Sharon, MDemail@example.com|
|Tel Aviv Sourasky Medical Center|
|Tel Aviv, Israel|
|Principal Investigator: Haggai Sharon, MD|