Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, AZ, USA.
Department of Anesthesiology, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
Curr Pain Headache Rep. 2020 Apr 22;24(6):24. doi: 10.1007/s11916-020-00860-0.
The purpose of this manuscript is to provide a comprehensive review of postdural puncture headache (PDPH) with a focus on epidemiology, pathophysiology, treatment, and prophylaxis.
PDPH is an adverse iatrogenic complication of neuraxial anesthesia that occurs following inadvertent puncture of the dura after epidural or spinal anesthesia. The overall incidence of PDPH after neuraxial procedures varies from 6 to 36%. The occurrence of PDPH can lead to increased patient morbidity, delayed discharge, and increased readmission. PDPH is a self-limiting postural headache that most often will resolve within 1 week, without need for treatment. Various prophylactic measures have been studied; however, more studies have been recommended to be undertaken in order to establish a proven benefit. For mild PDPH, conservative treatments are currently focused around bed rest, as well as oral caffeine. For moderate-to-severe PDPH, epidural blood patch (EBP) remains the most effective treatment; however, this invasive treatment is not without inherent risks. Further less invasive treatments have been explored such as epidural saline, dextran 40 mg solutions, hydration, caffeine, sphenopalatine ganglion blocks, greater occipital nerve blocks, and surgical closure of the gap; all have shown promise. Further studies are essential to prove efficacy as well as safety over the proven treatment of epidural blood patches. There is still limited evidence in literature about the understanding of PDPH and optimal treatment.
本文旨在全面综述硬脊膜穿破后头痛（PDPH），重点关注其流行病学、病理生理学、治疗和预防。
PDPH 是椎管内麻醉的一种医源性不良并发症，发生在硬脊膜意外穿破后，继之行硬膜外或脊髓麻醉。神经轴手术后 PDPH 的总发生率为 6%至 36%。PDPH 的发生会导致患者发病率增加、出院延迟和再入院增加。PDPH 是一种自限性体位性头痛，通常在 1 周内自行缓解，无需治疗。已对各种预防措施进行了研究；然而，为了确定其益处，仍需要进行更多的研究。对于轻度 PDPH，保守治疗目前集中在卧床休息和口服咖啡因。对于中重度 PDPH，硬膜外血贴（EBP）仍然是最有效的治疗方法；然而，这种有创治疗并非没有固有风险。进一步探索了一些微创治疗方法，如硬膜外盐水、40mg 右旋糖酐溶液、水化、咖啡因、蝶腭神经节阻滞、枕大神经阻滞和硬脊膜裂孔缝合术；所有这些方法都显示出了希望。需要进一步的研究来证明其疗效和安全性，以替代已证实的硬膜外血贴治疗。目前，关于 PDPH 的理解和最佳治疗方法的文献证据仍然有限。
