Darvish B, Gupta A, Alahuhta S, Dahl V, Helbo-Hansen S, Thorsteinsson A, Irestedt L, Dahlgren G
Department of Anesthesia and Intensive Care, School of Health and Medical Sciences, Örebro University Hospital, Örebro, Sweden.
Acta Anaesthesiol Scand. 2011 Jan;55(1):46-53. doi: 10.1111/j.1399-6576.2010.02335.x. Epub 2010 Oct 29.
a major risk with epidural analgesia is accidental dural puncture (ADP), which may result in post-dural puncture headache (PDPH). This survey was conducted to explore the incidence of ADP, the policy for management of PDPH and the educational practices in epidural analgesia during labour in the Nordic countries.
a postal questionnaire was sent to the anaesthesiologist responsible for Obstetric anaesthesia service in all maternity units (n=153) with questions relating to the year 2008.
the overall response rate was 93%. About 32% (22-47%) of parturients received epidural analgesia for labour. There were databases for registering obstetric epidural complications in 13% of Danish, 24% of Norwegian and Swedish, 43% of Finnish and 100% of hospitals in Iceland. The estimated incidence of ADP was 1% (n approximately 900). Epidural blood patch (EBP) was performed in 86% (n≈780) of the parturients. The most common time interval from diagnosis to performing EBP was 24-48 h. The success rate for EBP was >75% in 67% (62-79%) of hospitals. The use of diagnostic CT/MRI before the first or the second EBP was exceptional. No major complication was reported. Teaching of epidurals was commonest (86%) in the non-obstetric population and 53% hospitals desired a formal training programme in obstetric analgesia.
we found the incidence of ADP to be approximately 1%. EBP was the commonest method used for its management, and the success rate was high in most hospitals. Formal training in epidural analgesia was absent in most countries and trainees first performed it in the non-obstetric population.
硬膜外镇痛的一个主要风险是意外硬膜穿刺（ADP），这可能导致硬膜穿刺后头痛（PDPH）。本次调查旨在探讨北欧国家分娩期间硬膜外镇痛时ADP的发生率、PDPH的处理策略以及相关教育实践。
向所有产科单位（n = 153）中负责产科麻醉服务的麻醉医师发送了一份与2008年相关问题的邮政问卷。
总体回复率为93%。约32%（22 - 47%）的产妇接受了分娩硬膜外镇痛。丹麦13%、挪威和瑞典24%、芬兰43%以及冰岛100%的医院有登记产科硬膜外并发症的数据库。ADP的估计发生率为1%（n约为900）。86%（n≈780）的产妇接受了硬膜外血贴（EBP）。从诊断到进行EBP的最常见时间间隔为24 - 48小时。67%（62 - 79%）的医院EBP成功率>75%。在首次或第二次EBP之前使用诊断性CT/MRI的情况极少。未报告重大并发症。在非产科人群中硬膜外麻醉教学最为常见（86%），53%的医院希望有产科镇痛的正式培训项目。
我们发现ADP的发生率约为1%。EBP是最常用的处理方法，大多数医院的成功率较高。大多数国家缺乏硬膜外镇痛的正规培训，实习生首先在非产科人群中进行操作。
