[Epidural patch with dextran 40 to prevent postdural puncture headache in an HIV patient: case report.]

Postdural puncture headache is a well-known complication of spinal and epidural anesthesia and, so far, its most effective treatment is the epidural blood patch. Nevertheless this is an invasive procedure subject to severe complications. Its use in special patient populations (HIV positive patients and leukemias) is controversial. Several alternatives have been reported. This study aimed at showing a case of prophylactic epidural dextran 40 patch in an HIV patient with previous history of headache following spinal anesthesia.

Male patient, 31 years old, 70 kg, physical status ASA II, HIV positive, presented for recurrent anal condylomatosis treatment, with a history of severe and limiting headache for two weeks following spinal anesthesia. (25G Quincke needle). During an L3-L4 epidural puncture attempt with an 18G Tuohy needle there was an accidental dural puncture. Twenty milliliters of 10% dextran 40 were administered twice through an epidural catheter. First, 150 minutes after anesthesia and then in the morning following surgery. Patient had no headache complaint and was discharged on the following day.

The use of a patch with colloid solutions, such as dextran 40, is not well established, but there are some successful reports and it is our understanding that its potential should be further investigated.