Radke K, Radke O C
Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Dresden, Deutschland.
Anaesthesist. 2013 Feb;62(2):149-61. doi: 10.1007/s00101-012-2115-0.
Headache following dural puncture is a typical complication of neuraxial analgesia and can impair the ability to perform activities of daily living up to incapacitation. The use of thin, atraumatic needles and special puncture techniques (e.g. reinsertion of the stylet) can prevent the majority of post-dural puncture headaches (PDPH). One of the most effective measures to prevent headache after accidental dural puncture is the intrathecal or epidural administration of morphine. When the diagnosis of PDPH is confirmed after excluding relevant differential diagnoses, some of which are potentially life-threatening, caffeine, theophylline and non-opioid analgesics are effective agents to reduce the severity of the symptoms. Traditional measures, such as strict bed rest and hyperhydration can no longer be recommended. If invasive treatment of the headache is warranted an epidural blood patch is still the method of choice with a high rate of success.
硬膜穿刺后头痛是椎管内镇痛的典型并发症，可损害日常生活活动能力，甚至导致失能。使用细的、无创伤的穿刺针及特殊穿刺技术（如重新插入针芯）可预防大多数硬膜穿刺后头痛（PDPH）。意外硬膜穿刺后预防头痛最有效的措施之一是鞘内或硬膜外注射吗啡。在排除一些可能危及生命的相关鉴别诊断后确诊为PDPH时，咖啡因、茶碱和非阿片类镇痛药是减轻症状严重程度的有效药物。不再推荐严格卧床休息和补液等传统措施。如果有必要对头痛进行有创治疗，硬膜外血贴仍是首选方法，成功率较高。
