From the Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York.
Department of Anesthesiology, Weill Cornell Medicine, New York, New York.
Anesth Analg. 2020 Jul;131(1):273-279. doi: 10.1213/ANE.0000000000004691.
Spinal anesthesia is known to have numerous benefits, including reductions in nausea and opioid consumption; however, postdural puncture headache (PDPH) remains a significant risk associated with this technique. The literature specifically examining this complication in adolescents is scarce. Our primary objective was therefore (1) to estimate the incidence of PDPH with a 27G pencil-point needle in patients between the ages of 12 and 19 undergoing ambulatory lower extremity procedures and (2) to compare it to the incidence in adults aged 20-45 years.
After institutional review board (IRB) approval, patients aged 12-45 years undergoing ambulatory lower extremity surgery were approached. Patients undergoing the procedure under combined spinal-epidural (CSE) or spinal anesthesia with a 27G pencil-point needle were eligible for enrollment. Patients were consented before surgery and received a survey via e-mail on postoperative day (POD) 4 inquiring about the presence of a headache. Each headache was described by the participant and assessed for severity, time of onset, duration, location, and whether it was of a postural nature. All patients reporting a postural headache were contacted by a physician author to confirm a diagnosis of PDPH using the International Headache Society diagnostic criteria.
A total of 656 patients were included in the analysis. Overall, 3.4% of patients developed PDPH. The percentage developing PDPH was 4.9% (3.0-7.8) among those aged 12-19 years and 1.8% (0.8-3.9) in the 20- to 45-year-old group. After adjusting for covariates, the age group between 12 and 19 years was associated with an almost 3-fold increase in the odds (2.8 [95% confidence interval {CI}, 1.1-7.3]) for the development of PDPH compared to that in the 20-45 age group. One patient in the adult group required an epidural blood patch.
The overall incidence for the development of PDPH in ambulatory patients <45 years of age is low. However, the odds for developing PDPH is significantly higher in teenagers compared to those aged 20-45 years. This increase was not associated with an increase in the need for an epidural blood patch. Providers may incorporate these data in their consent process and have a higher index of suspicion for PDPH in teenagers who report headaches after neuraxial anesthesia.
椎管内麻醉具有许多益处，包括减少恶心和阿片类药物的消耗；然而，硬膜穿破后头痛（PDPH）仍然是与该技术相关的重大风险。专门研究青少年这一并发症的文献很少。因此，我们的主要目标是：（1）估计在接受门诊下肢手术的 12-19 岁患者中，使用 27G 笔尖针进行椎管内麻醉后 PDPH 的发生率；（2）并将其与 20-45 岁成人的发生率进行比较。
在机构审查委员会（IRB）批准后，对接受门诊下肢手术的 12-45 岁患者进行了调查。符合条件的患者包括接受单次腰麻或腰硬联合麻醉的患者，使用的是 27G 笔尖针。在手术前获得患者同意，并在术后第 4 天通过电子邮件向患者发送一份调查问卷，询问是否有头痛。每位头痛患者均由一位医生作者进行描述，并根据严重程度、发作时间、持续时间、位置以及是否与姿势有关进行评估。所有报告有体位性头痛的患者均通过医生联系，以根据国际头痛协会的诊断标准确诊为 PDPH。
共纳入 656 例患者进行分析。总体而言，3.4%的患者发生 PDPH。12-19 岁患者中发生 PDPH 的比例为 4.9%（3.0-7.8），20-45 岁患者为 1.8%（0.8-3.9）。在调整协变量后，12-19 岁年龄组发生 PDPH 的几率几乎是 20-45 岁年龄组的 3 倍（2.8 [95%置信区间 {CI}，1.1-7.3]）。成人组中有 1 例患者需要硬膜外血贴。
在 45 岁以下的门诊患者中，PDPH 的总体发生率较低。然而，与 20-45 岁年龄组相比，青少年发生 PDPH 的几率显著更高。这种增加与硬膜外血贴的需求增加无关。医务人员可以在知情同意过程中纳入这些数据，并对报告神经轴麻醉后头痛的青少年提高对 PDPH 的警惕性。
