Lacombe Alexandre, Downey Kristi, Ye Xiang Y, Carvalho Jose C A
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Reg Anesth Pain Med. 2022 Jun;47(6):364-369. doi: 10.1136/rapm-2021-103266. Epub 2022 Mar 25.
Epidural analgesia is the preferred method to manage pain during labor and delivery. The insertion of the epidural catheter can be complicated by unintentional dural puncture that may result in postdural puncture headache. There is limited evidence on the long-term implications of this complication. We sought to investigate if women who sustained a dural puncture have a higher risk of developing chronic headache, low back pain and visual or auditory impairment.
We conducted a 1:1 case-control study with women who delivered at our institution from January 2015 to December 2019. Cases were women who received epidural analgesia and sustained an unintentional dural puncture, and controls were women who received epidural analgesia but did not sustain such complication. We matched cases and controls for date of delivery, age, and body mass index. All women completed an online survey with validated questionnaires for diagnosis of chronic headache and chronic back pain. We used dichotomic (yes/no) questions to look for the presence of chronic visual and auditory impairment.
Sixty-three case-control pairs were studied. Women who sustained a dural puncture during their epidural catheter insertion had a higher risk of developing chronic headache (14.3%, vs 4.8%, p=0.057, adjusted OR (AOR): 3.67 (95% CI 1.05 to 12.82)) and chronic back pain (39.7% vs 19.1%, p=0.009, AOR: 2.67 (95% CI 1.25 to 5.72)) than women who did not sustain a dural puncture. The incidence of chronic auditory impairment was also higher in the dural puncture group (14.3% vs 1.6%, p=0.01, AOR: 9.98 (95% CI 1.21 to 82.62)).
An unintentional dural puncture during epidural catheter insertion in parturients is associated with increased risk of chronic headache, back pain and auditory impairment.
硬膜外镇痛是分娩期间控制疼痛的首选方法。硬膜外导管置入可能因意外硬膜穿刺而变得复杂，这可能导致硬膜穿刺后头痛。关于这种并发症的长期影响的证据有限。我们试图调查发生硬膜穿刺的女性患慢性头痛、腰痛以及视觉或听觉障碍的风险是否更高。
我们对2015年1月至2019年12月在我院分娩的女性进行了1:1病例对照研究。病例为接受硬膜外镇痛并发生意外硬膜穿刺的女性，对照为接受硬膜外镇痛但未发生此类并发症的女性。我们根据分娩日期、年龄和体重指数对病例和对照进行匹配。所有女性都完成了一份在线调查问卷，问卷采用经过验证的用于诊断慢性头痛和慢性背痛的量表。我们使用二分法（是/否）问题来查找慢性视觉和听觉障碍的存在情况。
研究了63对病例对照。在硬膜外导管置入期间发生硬膜穿刺的女性患慢性头痛（14.3%，对比4.8%，p = 0.057，调整后比值比（AOR）：3.67（95%置信区间1.05至12.82））和慢性背痛（39.7%对比19.1%，p = 0.009，AOR：2.67（95%置信区间1.25至5.72））的风险高于未发生硬膜穿刺的女性。硬膜穿刺组慢性听觉障碍的发生率也更高（14.3%对比1.6%，p = 0.01，AOR：9.98（95%置信区间1.21至82.62））。
产妇硬膜外导管置入期间的意外硬膜穿刺与慢性头痛、背痛和听觉障碍风险增加有关。
