Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study. (December 2020)

• Record Type: Journal Article
• Authors: Gupta, Anil; von Heymann, Christian; Magnuson, Anders; Alahuhta, Seppo; Fernando, Roshan; Van de Velde, Marc; Mercier, Frédéric J.; Schyns-van den Berg, Alexandra M.J.V.; Casier, Isabelle; Bryon, Bart; Soetens, Filiep; Dewandre, Pierre-Yves; Lambert, Geraldine; Christiaen, Jan; Schepers, Roel; Van Houwe, Patrick; Kalmar, Alain; Vanoverschelde, Henk; Bauters, Monique; Roofthooft, Eva; Devroe, Sarah; Van de Velde, Marc; Jadrijevic, Ana; Jokic, Aleksandra; Marin, Damjan; Sklebar, Ivan; Mihaljević, Slobodan; Kosinova, Martina; Stourac, Petr; Adamus, Milan; Kufa, Christian; Volfová, Ivana; Zaoralová, Blažena; Froeslev-Friis, Christina; Mygil, Bjoern; Krebs Albrechtsen, Charlotte; Kavasmaa, Tomi; Alahuhta, Seppo; Mäyrä, Anne; Mennander, Susanna; Rautaneva, Kati; Hiekkanen, Tuula; Kontinen, Vesa; Linden, Kirsti; Toivakka, Sara; Boselli, Emmanuel; Greil, Pierre-Édouard; Mascle, Olivier; Courbon, Aurelie; Lutz, Jean; Simonet, Thérèse; Barbier, Marie; Hlioua, Tarik; Meniolle d'Hauthville, Fleur; Quintin, Christine; Bouattour, Karim; Lecinq, Agnès; Soued, Mickaël; Bonnet, Marie-Pierre; Carbonniere, Mathieu; Fischer, Catherine; Picard, Paola-Carla; Bonnin, Martine; Storme, Brigitte; Bouthors, Anne-Sophie; Detente, Thomas; Nguyen Troung, Minh; Keita, Hawa; Nebout, Sophie; Osse, Lauranne; Delmas, Anne; Vial, Florence; Kaufner, Lutz; Hoefing, Christoph; Mueller, Stefan; Becke, Karin; Blobner, Manfred; Lewald, Heidrun; Schaller, Stefan Josef; Muggleton, Ellis; Bette, Birgit; Neumann, Claudia; Weber, Stefan; Grünewald, Matthias; Ohnesorge, Henning; Helf, Antonia; Jelting, Yvonne; Kranke, Peter; von Heymann, Christian; Welfle, Sabine; Staikou, Chryssoula; Stavrianopoulou, Antonia; Tsaroucha, Athanasia; Kalopita, Konstantina; Loukeri, Anastasia; Valsamidis, Dimitrios; Matsota, Paraskevi; Thorsteinsson, Adalbjörn; Tome, Riad; Eidelman, Leonid A.; Davis, Atara; Orbach-Zinger, Sharon; Ioscovich, Alexander; Ramona, Iacob; De Simone, Luigi; Pesetti, Barbara; Brazzi, Luca; Zito, Alessandro; Camorcia, Michela; Della Rocca, Giorgio; Aversano, Marco; Frigo, Maria Grazia; Todde, Cristina; Morina, Qamile; Macas, Andrius; Keraitiene, Grazina; Rimaitis, Kestutis; Borg, Francis; Tua, Carl; Kuijpers-Visser, Agnes Geertje; Schyns-van den Berg, Alexandra; Hollmann, Markus W.; Van den Berg, Tijs; Koolen, Eric; Dons, Ilse; van der Knijff, Anouk; van der Marel, Caroline; Ruysschaert, Nele; Pelka, Michal; Pluymakers, Christine; Koopman, Seppe; Teunissen, Aart-Jan; Cornelisse, Dick; van Dasselaar, Nick; Verdouw, Bastiaan; Beenakkers, Ingrid; Dahl, Vegard; Hagen, Robert; Vivaldi, Francesco; Eriksen, John Reidar; Wiszt, Radovan; Aslam Tayyaba, Naz; Ringvold, Else-Marie; Chutkowski, Radosław; Skirecki, Tomasz; Wódarski, Bartłomiej; Faria, Maria Aida; Ferreira, Amélia; Sampaio, Ana Catarina; Ferreira, Irene; Matias, Bernardo; Teixeira, Joana; Araujo, Rita; Cabido, Herminia; Fortuna, Rosario; Lemos, Paulo; Cardoso, Carolina; Moura, Fernando; Pereira, Cristiana; Pereira, Sandra; Tavares, Francisca; Vasconcelos, Pedro; Abecasis, Manuel; Lança, Filipa; Muchacho, Paulo; Ormonde, Lucindo; Guedes-Araujo, Isabel; Pinho-Oliveira, Vitor; Paredes, Paulo; Bentes, Carla; Gouveia, Francisco; Milheiro, Ana; Castanheira, Cláudia; Neves, Miriam; Pacheco, Vânia; Cortez, Mara; Tranquada, Raquel; Tareco, Glória; Furtado, Inês; Pereira, Estela; Marinho, Luísa; Seabra, Manue; Bulasevic, Aleksandra; Kendrisic, Mirjana; Jovanovic, Lidija; Pujić, Borislava; Kutlesic, Marija; Grochova, Monika; Simonova, Jana; Pavlovic, Gordana; Rozman, Ales; Blajic, Iva; Graovac, Dragan; Stopar Pintraic, Tatjana; Chiquito, Teresa; Monedero, Pablo; Carlos-Errea, De Joaquin; Guillén-Casbas, Roque; Veiga-Gil, Leonor; Basso, Morena; Garcia Bartolo, Carolina; Hernandez, Cristian; Ricol, Laura; De Santos, Maroto Pinar; Gràcia Solsona, Josep A.; López-Baamonde, Manuel; Magaldi Mendaña, Marta; Plaza Moral, Ana María; Vendrell, Marina; Trillo, Lourdes; Perez Garcia, Anibal Ricardo; Alamillo Salas, Clara; Moret, Enric; Ramió, Laura; Aguilar Sanchez, Jose Luis; Soler Pedrola, Maria; Valldeperas Hernandez, Maria Inmaculada; Aldalur, Gorka; Bárcena, Estíbaliz; Herrera, Julia; Iturri, Fernando; Martínez, Alberto; Martínez, Leire; Serna, Rosa; Gilsanz, Fernando; Guasch Arevalo, Emilia; Iannuccelli, Fabrizio; Latorre, Julieta; Rodriguez Roca, Cristina; Pérez Pardo, Osvaldo Ceferino; Sierra Biddle, Natalia; Suárez Cendaña, Ceferina; Hernández González, Lourdes; Remacha González, Caridad; Sánchez Nuez, Raquel; Anta, Diego; Beleña, Jose M.; García-Cuadrado, Carmen; Garcia, Irene; Manrique, Susana; Suarez, Elena; Hein, Anette; Arbman, Elisabet; Hansson, Helena; Tillenius, Monika; Al-Taie, Ruaa; Ledin-Eriksson, Susanne; Lindén-Söndersö, Anja; Rosén, Ola; Austruma, Evija; Gillberg, Lars; Darvish, Bijan; Gupta, Anil; Nordstöm, Johan L.; Persson, Jan; Rosenberg, Jan; Brühne, Lars; Forshammar, Johan; Ugarph Edfeldt, Malin; Rolfsson, Håkan; Hellblom, Anna; Levin, Katarina; Rabow, Sofus; Thorlacius, Karin; Bansch, Peter; Robertson (Baeriswyl), Moira; Stamer, Ulrike; Mathivon, Stanislas; Savoldelli, Georges; Auf der Maur, Pia; Filipovic, Miodrag; Dullenkopf, Alexander; Brunner, Maya; Girard, Thierry; Vonlanthen, Claudia; Ozbilgin, Sule; Gunaydin D, Berrin; Corman Dincer, Pelin; Tas Tuna, Ayca;
• Is Part Of: British journal of anaesthesia. Volume 125:Number 6(2020)
• Page Start: 1045
• Page End: 1055
• Publication Date: 2020-12
• Subjects: accidental dural puncture -- epidural analgesia -- epidural blood patch -- obstetrics -- postdural puncture headache; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2020.07.061
• Languages: English
• ISSNs: 0007-0912

Abstract

Abstract: Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.