Frimley Health Foundation Trust, Surrey.
St George's University London Medical School, London.
Curr Opin Anaesthesiol. 2024 Oct 1;37(5):533-540. doi: 10.1097/ACO.0000000000001399. Epub 2024 May 31.
Accidental dural puncture (ADP) and postdural puncture headache (PDPH) are relatively common complications of neuraxial anaesthesia and analgesia in obstetrics. Both may result in acute and chronic morbidity. This review intends to discuss the chronic implications of ADP and PDPH and raise awareness of severe and potentially life-threatening conditions associated with them.
ADP may be associated with a high rate of PDPH, prolonged hospitalization and increased readmissions. Studies have shown that PDPH may lead to chronic complications such as post-partum depression (PPD), post-traumatic stress disorder (PTSD), chronic headache, backache and reduced breastfeeding rates. There are many case reports indicating that major, severe, life-threatening neurologic complications may follow PDPH in obstetric patients including subdural haematoma and cerebral venous thrombosis.
Many clinicians still believe that ADP and PDPH are benign and self-limiting conditions whereas there may be serious and devastating consequences of both. It is imperative that all women with ADP and PDPH are appropriately diagnosed and treated.
意外硬脊膜穿刺（ADP）和硬脊膜穿破后头痛（PDPH）是产科椎管内麻醉和镇痛的相对常见的并发症。两者都可能导致急性和慢性发病。本文旨在讨论 ADP 和 PDPH 的慢性影响，并提高对与之相关的严重和潜在威胁生命的情况的认识。
ADP 可能与较高的 PDPH 发生率、延长住院时间和增加再入院率有关。研究表明，PDPH 可能导致慢性并发症，如产后抑郁症（PPD）、创伤后应激障碍（PTSD）、慢性头痛、背痛和母乳喂养率降低。有许多病例报告表明，产科患者中 PDPH 可能导致严重、威胁生命的神经系统并发症，包括硬膜下血肿和脑静脉血栓形成。
许多临床医生仍然认为 ADP 和 PDPH 是良性和自限性的疾病，但两者都可能产生严重和毁灭性的后果。所有发生 ADP 和 PDPH 的妇女都必须得到适当的诊断和治疗。
