Kleine-Brüggeney Maren, Kranke Peter, Stamer Ulrike M
Klinik für Anästhesiologie und Schmerztherapie des Inselspitals, Universitätsklinikum Bern.
Anasthesiol Intensivmed Notfallmed Schmerzther. 2011 Jul;46(7-8):516-24. doi: 10.1055/s-0031-1284471. Epub 2011 Aug 4.
Since the first description of spinal and epidural anaesthesia, postdural puncture headache (PDPH) is a well known complication. Its prophylaxis and treatment has been studied and discussed for more than 100 years, but the evidence is still limited. Due to relatively low prevalence of PDPH, prospective RCTs are often missing, and the frequently self-limiting character of PDPH impedes an adequate interpretation of results from studies without a control group. Taking side effects and complications into account, a prophylactic treatment of PDPH cannot be recommended. In case of PDPH, non-opioid analgesics are the first choice treatment. The epidural blood patch remains the mainstay of severe PDPH therapy. Noninvasive therapies like theophylline, sumatriptan and ACTH can be an alternative. However, an evidence-based recommendation is lacking. The development of standard operating procedures for accidental dural punctures and PDPH is recommended.
自首次描述脊髓麻醉和硬膜外麻醉以来，硬膜穿刺后头痛（PDPH）就是一种广为人知的并发症。其预防和治疗已经研究和讨论了100多年，但证据仍然有限。由于PDPH的发病率相对较低，前瞻性随机对照试验常常缺失，而且PDPH通常具有自限性，这妨碍了对无对照组研究结果的充分解读。考虑到副作用和并发症，不建议对PDPH进行预防性治疗。对于PDPH，非阿片类镇痛药是首选治疗方法。硬膜外血贴仍然是重度PDPH治疗的主要手段。氨茶碱、舒马曲坦和促肾上腺皮质激素等非侵入性疗法可以作为一种替代方法。然而，目前缺乏基于证据的推荐。建议制定意外硬膜穿刺和PDPH的标准操作程序。
