Sekar’s DISH10 (Deep Inspiration, Squeeze & Hold for 10 Seconds) Maneuver- A Noninvasive Treatment for Postdural Puncture Headache

Abstract

Postdural puncture headache (PDPH), also called post-spinal or meningeal puncture headaches, is a well-known iatrogenic complication following neuraxial anesthesia, therapeutic or diagnostic meningeal puncture. Its incidence has steadily declined with the advances in anesthetic techniques, improved knowledge of pathophysiology, a better understanding of the risk factors, and the implementation of preventable measures. However, many issues relating to its management still need to be explored further in order to address, control, and prevent such a rare but dreaded complication. Among various pharmacological and non-pharmacological treatment options, an epidural blood patch (EBP) is considered to be the gold standard in the treatment of PDPH. Given the difficulties of performing invasive techniques like EBP and their potential side effect profile, it is time to look for more efficient, cost-effective, and noninvasive techniques. The Sekar’s DISH10 (Deep Inspiration, Squeeze, and Hold for 10 seconds) maneuver is one such noninvasive technique that was recently described and claimed to provide faster symptomatic relief than other available techniques by speeding up spontaneous recovery.

This chapter provides an overview of the pathophysiology associated with PDPH and elaborates the key steps of the DISH10 maneuver and its various biomechanics. We expect the DISH10 maneuver to gain popularity and wide acceptance in the future due to its ease of execution, cost efficiency,  and non-invasiveness.