Norris M C, Leighton B L
Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107.
Reg Anesth. 1990 Nov-Dec;15(6):285-7.
Headache after unintentional dural puncture with 17- or 18-gauge needles represents a significant source of anesthetic-induced maternal morbidity. We performed this study to determine whether inserting a catheter into the subarachnoid space after dural puncture can significantly alter the incidence of headache. Thirty-five women, requesting labor analgesia, suffered a dural puncture during attempts to identify the epidural space using an 18-gauge Hustead needle (bevel oriented parallel to the longitudinal axis of the back). Subsequently, the anesthesiologist inserted a 20-gauge polyamide catheter into the CSF and provided continuous spinal anesthesia throughout labor and delivery. A second group of 21 women suffered dural puncture with the same epidural technique but without subarachnoid catheter insertion. These women subsequently received lumbar epidural anesthesia. After delivery, we visited all women daily until discharge and questioned them about the presence and severity of headache. Neither the incidence of headache nor the need for therapeutic blood patch differed significantly between the two groups of women. No other anesthetic related complications ensued. Continuous spinal anesthesia after unintentional dural puncture does not decrease the incidence of headache in parturients.
使用17号或18号针意外穿破硬脊膜后出现的头痛是麻醉导致产妇发病的一个重要原因。我们开展这项研究以确定在硬脊膜穿破后将导管插入蛛网膜下腔是否能显著改变头痛的发生率。35名要求分娩镇痛的女性在使用18号Hustead针（斜面与背部纵轴平行）试图确定硬膜外间隙时发生了硬脊膜穿破。随后，麻醉医生将一根20号聚酰胺导管插入脑脊液，并在整个分娩过程中提供连续脊麻。第二组21名女性采用相同的硬膜外技术发生了硬脊膜穿破，但未插入蛛网膜下腔导管。这些女性随后接受了腰段硬膜外麻醉。分娩后，我们每天探访所有女性直至出院，并询问她们是否头痛以及头痛的严重程度。两组女性的头痛发生率和治疗性血补丁的需求均无显著差异。未出现其他与麻醉相关的并发症。意外硬脊膜穿破后进行连续脊麻并不能降低产妇头痛的发生率。
