Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Curr Opin Anaesthesiol. 2013 Jun;26(3):296-303. doi: 10.1097/ACO.0b013e328360b015.
To identify newly identified risk factors for the development of a postdural puncture headache (PDPH) as well as to outline the key points in the management of unintentional dural puncture and of PDPH.
The lack of experience of the proceduralist and a vaginal delivery are two risk factors that increase the risk of the patient developing a PDPH. The use of intrathecal catheters for the prevention of a headache is not of value, although an intrathecal catheter may prove to be the best method for providing analgesia for the patient. When performing an epidural blood patch, the optimal amount of blood is 20 ml, as long as the patient does not develop the symptoms of back pain or leg pain during the injection.
Many practitioners do not practice an evidence-based approach to the management of unintentional dural puncture and PDPH. Written institutional protocols are important to insure that patients receive the optimal care.
确定新发现的与发生硬脊膜穿破后头痛（PDPH）相关的风险因素，并概述处理意外硬脊膜穿破和 PDPH 的要点。
术者经验不足和阴道分娩是增加患者发生 PDPH 风险的两个危险因素。预防性使用鞘内导管并不能预防头痛，但对于提供患者镇痛来说，鞘内导管可能是最佳方法。行硬膜外血贴时，只要注射过程中患者未出现背痛或腿痛症状，最佳注射量为 20 毫升。
许多从业者并未采用循证方法来处理意外硬脊膜穿破和 PDPH。制定书面机构方案对于确保患者获得最佳治疗非常重要。
