Consultants in Anaesthesia, Department of Anaesthesia & Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Specialist Trainee in Anaesthesia, Department of Anaesthesia & Pain Medicine, Clinical Research Unit in Pain Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK.
Headache. 2019 Jan;59(1):97-103. doi: 10.1111/head.13442. Epub 2018 Nov 13.
The aim of the prospective longitudinal service evaluation was to reveal the incidence of persistent headache at 18 months following accidental dural puncture with a 16-gauge Tuohy needle. This followed an observation that a subset of female patients was presenting to the local pain medicine clinic with persistent headache following an accidental dural puncture.
Two thirds of patients with an accidental dural puncture develop post dural puncture headache that is believed to be a self-limiting condition. There is emerging evidence from retrospective studies that post dural puncture headache can result in persistent headache.
Prospective longitudinal service evaluation in obstetric patients who suffered an accidental dural puncture headache. Patients provided written consent for telephone follow-up at 6, 12, and 18 months. Patients reporting persistent headache were reviewed at a pain medicine clinic for further investigations and management.
Over an 18-month period, 45 patients suffered accidental dural puncture. Five patients declined consent. One patient was lost to follow-up. Of the 39 patients who completed follow-up, 12 patients (30%) reported persistent headache at 18 months. Six patients reported new onset headache while 6 patients reported worsening of pre-existing headache.
Post dural puncture headache from an accidental dural puncture can no longer be considered a self-limiting condition. Current evidence probably mandates the addition of persistent headache as one of the potential complications of an epidural insertion during informed consent process.
本前瞻性纵向服务评估旨在揭示在使用 16 号 Tuohy 针进行意外硬脊膜穿刺后 18 个月持续性头痛的发生率。此前观察到，一部分女性患者在意外硬脊膜穿刺后到当地疼痛医学诊所就诊时出现持续性头痛。
三分之二的意外硬脊膜穿刺患者会出现硬脊膜穿刺后头痛，据信这是一种自限性疾病。越来越多的回顾性研究证据表明，硬脊膜穿刺后头痛可导致持续性头痛。
对意外硬脊膜穿刺头痛的产科患者进行前瞻性纵向服务评估。患者提供书面同意，以便在 6、12 和 18 个月时进行电话随访。报告持续性头痛的患者在疼痛医学诊所进行进一步检查和管理。
在 18 个月的时间里，45 名患者发生意外硬脊膜穿刺。5 名患者拒绝同意。1 名患者失访。39 名完成随访的患者中，12 名（30%）患者在 18 个月时报告持续性头痛。6 名患者报告新发头痛，6 名患者报告原有头痛加重。
意外硬脊膜穿刺后的硬脊膜穿刺后头痛不再被认为是自限性疾病。目前的证据可能需要在知情同意过程中增加持续性头痛作为硬膜外插入的潜在并发症之一。
