Department of Anesthesiology, Baskent University Adana Teaching and Medical Research Center, Adana, Turkey.
J Anesth. 2010 Feb;24(1):43-8. doi: 10.1007/s00540-009-0858-9.
We investigated whether inserting an intrathecal catheter and leaving it in place for 24 h after an unintentional dural puncture in orthopedic patients reduced the incidence of post-dural puncture headache (PDPH).
The study consisted of 427 patients in whom a total of 21 unintentional dural punctures had occurred during orthopedic surgery performed between 2002 and 2006. Seven patients (phase I; evaluated retrospectively) each underwent placement of an epidural catheter at another level after dural puncture during the period January 2002 to February 2004. Fourteen patients (phase II; evaluated prospectively) received an epidural catheter through the dural tear after an unintentional dural puncture during the period February 2004-March 2006
In phase I, 5 of the 7 patients experienced PDPH, and one required an epidural blood patch. In phase II, only one of the 14 patients complained of PDPH, which resolved after 48 h of medical therapy. No patient experienced paresthesia, neurologic or hemorrhagic complication, or infection.
Inserting an epidural catheter through the dural tear following an unintentional dural puncture and leaving it in place for 24 h significantly reduces the incidence of PDPH.
我们研究了在骨科患者中，在非故意的硬脊膜穿刺后插入椎管内导管并留置 24 小时是否会降低硬脊膜穿刺后头痛（PDPH）的发生率。
该研究纳入了 427 例患者，在 2002 年至 2006 年期间进行的骨科手术中，总共发生了 21 例非故意的硬脊膜穿刺。7 例患者（I 期；回顾性评估）在 2002 年 1 月至 2004 年 2 月期间，在硬脊膜穿刺后于另一水平插入硬膜外导管。14 例患者（II 期；前瞻性评估）在 2004 年 2 月至 2006 年 3 月期间，在非故意的硬脊膜穿刺后通过硬脊膜撕裂处接受了硬膜外导管。
在 I 期，7 例患者中有 5 例发生 PDPH，1 例需要硬膜外血贴。在 II 期，14 例患者中仅有 1 例出现 PDPH，经 48 小时药物治疗后缓解。无患者出现感觉异常、神经或出血并发症或感染。
在非故意的硬脊膜穿刺后，通过硬脊膜撕裂处插入硬膜外导管并留置 24 小时可显著降低 PDPH 的发生率。
