Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, UK.
Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Anaesthesia. 2021 Aug;76(8):1068-1076. doi: 10.1111/anae.15491. Epub 2021 Apr 23.
Accidental dural puncture following epidural insertion can cause a post-dural headache that is defined by the International Headache Society as self-limiting. We aimed to confirm if accidental dural puncture could be associated with persistent headache and back pain when compared with matched control parturients. We performed a prospective multicentre cohort study evaluating the incidence of persistent headache following accidental dural puncture at nine UK obstetric units. Parturients who sustained an accidental dural puncture were matched with controls who had undergone an uneventful epidural insertion. Participants were followed-up at six-monthly intervals for 18 months. Primary outcome was the incidence of persistent headache at 18 months. Ninety parturients who had an accidental dural puncture were matched with 180 controls. The complete dataset for primary analysis was available for 256 (95%) participants. Incidence of persistent headache at 18 months was 58.4% (52/89) in the accidental puncture group and 17.4% (29/167) in the control group, odds ratio (95%CI) 18.4 (6.0-56.7), p < 0.001, after adjustment for past history of headache, Hospital Anxiety and Depression Scale (depression) and Hospital Anxiety and Depression Scale (anxiety) scores. Incidence of low back pain at 18 months was 48.3% (43/89) in the accidental puncture group and 17.4% (29/167) in the control group, odds ratio (95%CI) 4.14 (2.11-8.13), with adjustment. We have demonstrated that accidental dural puncture is associated with long-term morbidity including persistent headache in parturients. This challenges the current definition of post-dural puncture headache as a self-limiting condition and raises possible clinical, financial and medicolegal consequences.
硬膜外穿刺意外导致的硬脊膜穿刺后头痛，被国际头痛协会定义为自限性头痛。我们旨在证实与匹配的对照组产妇相比，硬脊膜穿刺意外是否与持续性头痛和背痛有关。我们在英国的 9 个产科单位进行了一项前瞻性多中心队列研究，评估了 9 例硬膜外穿刺意外产妇的持续性头痛发生率。将发生硬脊膜穿刺意外的产妇与进行无并发症硬膜外穿刺的对照组产妇相匹配。参与者在 18 个月内每 6 个月随访一次。主要结局为 18 个月时持续性头痛的发生率。90 例发生硬脊膜穿刺意外的产妇与 180 例对照组产妇相匹配。主要分析的完整数据集可用于 256 名（95%）参与者。在意外穿刺组中，18 个月时持续性头痛的发生率为 58.4%（52/89），在对照组中为 17.4%（29/167），比值比（95%CI）为 18.4（6.0-56.7），p<0.001，调整头痛病史、医院焦虑抑郁量表（抑郁）和医院焦虑抑郁量表（焦虑）评分后。在意外穿刺组中，18 个月时腰背疼痛的发生率为 48.3%（43/89），在对照组中为 17.4%（29/167），比值比（95%CI）为 4.14（2.11-8.13），经调整。我们已经证明，硬脊膜穿刺意外与产妇的长期发病率有关，包括持续性头痛。这挑战了硬脊膜穿刺后头痛作为自限性疾病的当前定义，并提出了可能的临床、财务和法医学后果。
