Department of Anesthesiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of the University of Pittsburgh Medical Center, 300 Halket Street Suite 3510, Pittsburgh, PA 15213, USA.
Department of Anesthesiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of the University of Pittsburgh Medical Center, 300 Halket Street Suite 3510, Pittsburgh, PA 15213, USA.
J Clin Anesth. 2019 Feb;52:58-62. doi: 10.1016/j.jclinane.2018.09.009. Epub 2018 Sep 11.
To examine the relationship between neuraxial morphine exposure after unintentional dural puncture and the risk for postdural puncture headache in obstetric patients.
Retrospective cohort study.
Obstetrical unit at a tertiary care referral center.
Parturients receiving labor epidural analgesia with recognized unintentional dural puncture.
Cases in which neuraxial morphine was given for any reason were compared to cases in which it was not for the outcome of postdural puncture headache.
Development of postdural puncture headache, headache severity, number of epidural blood patches, hospital length of stay.
Of the 80 cases that were included, 38 women received neuraxial morphine and 42 did not. There was no significant difference in the incidence of headache between the two morphine groups (Headache present: Morphine: 27/56 [48.2%], No morphine: 29/56 [51.8%]; Headache free: Morphine: 11/24 [45.8%], No morphine: 13/24 [54.2%], P = 0.84). There was no difference in the need for epidural blood patch (Morphine: 24/42 [57.1%], No morphine: 18/38 [47.4%], P = 0.50) and headache severity (mean headache pain score: Morphine: 7.9 ± 1.8 vs. No morphine: 7.3 ± 2.4, P = 0.58). Hospital length of stay was higher in the morphine group (4.4 ± 2.9 days vs. 3.0 ± 1.5 days respectively, P = 0.008). Using logistic regression, morphine did not affect headache risk after controlling for covariates (morphine vs. no morphine: adjusted OR 1.24 [0.75]; P = 0.72; pre-eclampsia vs. no pre-eclampsia: adjusted OR 0.56 [0.41], P = 0.42; cesarean vs. normal spontaneous vaginal delivery: adjusted OR 0.97 [0.67]; P = 0.96).
In cases of unintentional dural puncture, exposure to neuraxial morphine for any reason may not be protective against the risk of postdural puncture headache. Although an overall protective effect of neuraxial morphine was not observed in this study, its role in specific subsets of patients remains to be investigated.
研究产科患者在意外硬脊膜穿刺后接受椎管内吗啡暴露与发生硬脊膜穿刺后头痛之间的关系。
回顾性队列研究。
三级转诊中心的产科病房。
接受分娩硬膜外镇痛且已知有意外硬脊膜穿刺的产妇。
无论出于何种原因，接受椎管内吗啡治疗的病例与未接受椎管内吗啡治疗的病例进行比较，以了解硬脊膜穿刺后头痛的结果。
硬脊膜穿刺后头痛的发生、头痛严重程度、硬膜外血补丁的数量、住院时间。
在纳入的 80 例病例中，38 例女性接受了椎管内吗啡，42 例未接受。两组吗啡组头痛发生率无显著差异（头痛存在：吗啡组：27/56 [48.2%]，无吗啡组：29/56 [51.8%]；头痛消失：吗啡组：11/24 [45.8%]，无吗啡组：13/24 [54.2%]，P=0.84）。硬膜外血补丁的需求也无差异（吗啡组：24/42 [57.1%]，无吗啡组：18/38 [47.4%]，P=0.50），头痛严重程度也无差异（平均头痛疼痛评分：吗啡组：7.9±1.8 分 vs. 无吗啡组：7.3±2.4 分，P=0.58）。吗啡组的住院时间较长（4.4±2.9 天 vs. 3.0±1.5 天，P=0.008）。使用逻辑回归，在控制协变量后，吗啡并未影响头痛风险（吗啡 vs. 无吗啡：调整后的 OR 1.24 [0.75]；P=0.72；子痫前期 vs. 无子痫前期：调整后的 OR 0.56 [0.41]，P=0.42；剖宫产 vs. 正常自然分娩：调整后的 OR 0.97 [0.67]，P=0.96）。
在意外硬脊膜穿刺的情况下，无论出于何种原因接受椎管内吗啡暴露，都可能无法预防硬脊膜穿刺后头痛的风险。尽管本研究未观察到椎管内吗啡的总体保护作用，但它在特定患者亚群中的作用仍有待研究。
