Post-dural puncture headache – not only a headache for the patient: guidelines and training in obstetric anaesthesia

Included in this edition of SAJAA is an important South African exploratory survey of management practices for post-dural puncture headache (PDPH), by Monteith et al. The authors investigated these practices within the context of a large academic department, and compared their findings with international guidelines.

An audit of anaesthetic charts at Chris Hani Baragwanath Academic Hospital

The anaesthetic chart is an important component of a patient’s health record in the perioperative period. The primary purpose of the chart is to document the clinical management of the patient presenting for anaesthetic. It also plays a vital role in guiding the future management of subsequent anaesthetics a patient may receive. Secondary functions of the chart include its usage for quality assurance, coding, departmental administration and, increasingly, in the medicolegal setting. It is often the sole documentation that the anaesthesiologist has of perioperative events. It, therefore, should be a comprehensive and concise reflection of the preoperative assessment, intraoperative anaesthetic events as well as postoperative monitoring. It has been said that the first line of defence in a medicolegal lawsuit is documentation.

A survey of post-dural puncture headache management practices within a South African academic department

A post-dural puncture headache (PDPH) is defined by the International Headache Society as a headache occurring within five days of a lumbar puncture, which is caused by cerebrospinal fluid leakage through the dura and is usually accompanied by neck stiffness and/or subjective hearing problems. PDPH is a common consequence of neuraxial anaesthesia for labour and/ or caesarean section with an overall incidence of approximately 1%, but it could be as high as 88% after accidental dural puncture (ADP) during the performance of epidural anaesthesia with the use of a 16 G Tuohy needle. It typically resolves spontaneously within two weeks, or after the administration of an epidural blood patch (EBP).

A prospective, multicentre, observational, cross-sectional study of the prevalence of blood transfusion associated with caesarean section in KwaZulu-Natal, South Africa

Obstetric haemorrhage remains one of the leading, but preventable, causes of maternal mortality worldwide, with low- and middle-income countries (LMICs) disproportionately affected. Bishop et al. identified a 50-fold increased mortality rate in Africa following caesarean section (CS) compared to high-income countries (HIC), which is strongly associated with peripartum haemorrhage. In South Africa, the risk of a woman dying after CS was three times higher than that for vaginal delivery, and bleeding during or after CS contributed to 15.7% of maternal mortality. Transfusion of blood products can be lifesaving. Identifying factors associated with blood transfusion (BT) may allow for appropriate preparation in the individual case and prompt mobilisation of limited blood resources, especially in limited-resource environments where lack of blood and blood products contributed to one-quarter of maternal deaths.

Comparative analgesic efficacy of adding magnesium sulphate to bupivacaine in serratus anterior plane block to reduce pain after mastectomy

Breast cancer is the most common cause of death due to cancer among women worldwide, and it is the most common cancer affecting women in Egypt; representing about one-fifth of the total cancer cases. Most breast cancer patients require breast surgery to remove the primary tumor and perform axillary staging or dissection. Approximately 40% of those patients experience clinically-significant, acute, postoperative pain, which is also an important risk factor for the development of persistent, chronic, postoperative pain.

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Southern African Journal of Anaesthesia and Analgesia - November/December 2022 Vol 28 No 6