DelPizzo Kathryn, Cheng Jennifer, Dong Naomi, Edmonds Chris R, Kahn Richard L, Fields Kara G, Curren Jodie, Rotundo Valeria, Zayas Victor M
Department of Anesthesiology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
Healthcare Research Institute, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA.
HSS J. 2017 Jul;13(2):146-151. doi: 10.1007/s11420-017-9541-0. Epub 2017 Mar 16.
The incidence of post-dural puncture headache (PDPH) arising from spinal anesthesia in the general population is low. However, patients under 45 years have been shown to exhibit a higher incidence of PDPH, even with small needles.
QUESTIONS/PURPOSES: This study aimed to estimate the incidence of PDPH from a 27G pencil-point needle in ambulatory surgery patients between the ages of 15-45 years and compare incidence of PDPH by age group, sex, and history of headache.
In this prospective cohort study, 300 patients (15-45 years old) who underwent simple knee arthroscopy under spinal anesthesia with a 27G pencil-point needle were enrolled. Verbal consent was obtained during the initial phone conversation between post-operative days (PODs) 2-5. A PDPH questionnaire was administered during this conversation and between PODs 7-10. Patients who reported a positional headache were contacted by a physician co-investigator, who determined PDPH diagnosis.
Five patients were excluded from analysis due to complicated operative procedures or spinal needle size. The overall PDPH incidence was 2.0% (95% CI 0.9-4.4; 6/295). PDPH incidence in 15-19-year-old patients was 16.7% (95% CI 4.7-44.8; 2/12). The crude relative risk of PDPH was 15.4 (95% CI 2.8-114.4) for patients with and without history of headache and 2.5 (95% CI 0.5-14.8) for females vs. males. Overall, 16.3% (95% CI 12.5-20.9) of patients reported post-operative, non-positional headaches.
There was a low overall incidence of PDPH among patients aged 15-45. Pre-planned subgroup analyses of PDPH incidence by age group revealed a high risk of PDPH among a small sample of 15-19-year-olds.
在普通人群中，脊髓麻醉引起的硬膜外穿刺后头痛（PDPH）发生率较低。然而，研究表明45岁以下的患者PDPH发生率较高，即使使用小针头也是如此。
问题/目的：本研究旨在评估15至45岁门诊手术患者使用27G笔尖式针头后PDPH的发生率，并比较不同年龄组、性别和头痛史患者的PDPH发生率。
在这项前瞻性队列研究中，纳入了300例（15至45岁）使用27G笔尖式针头在脊髓麻醉下接受简单膝关节镜检查的患者。在术后第2至5天的首次电话交谈中获得口头同意。在此次交谈期间以及术后第7至10天发放PDPH问卷。报告有体位性头痛的患者由医师共同研究者联系，后者确定PDPH诊断。
由于手术操作复杂或脊髓穿刺针尺寸问题，5例患者被排除在分析之外。总体PDPH发生率为2.0%（95%CI 0.9 - 4.4；6/295）。15至19岁患者的PDPH发生率为16.7%（95%CI 4.7 - 44.8；2/12）。有头痛史和无头痛史患者的PDPH粗相对风险为15.4（95%CI 2.8 - 114.4），女性与男性相比为2.5（95%CI 0.5 - 14.8）。总体而言，16.3%（95%CI 12.5 - 20.9）的患者报告有术后非体位性头痛。
15至45岁患者中PDPH的总体发生率较低。按年龄组对PDPH发生率进行的预先计划的亚组分析显示，一小部分15至19岁的患者发生PDPH的风险较高。
