Thomas Jeffrey, Soloniuk Leonard J, Mehdizadeh Chris, Cheng Peter, Sinha Ashish
Department of Anesthesiology and Perioperative Medicine, Riverside University Health Systems, Moreno Valley, CA, USA.
Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
BMC Anesthesiol. 2025 Jan 11;25(1):25. doi: 10.1186/s12871-025-02896-4.
Post-dural puncture headache (PDPH) is a debilitating complication of neuraxial anesthesia, particularly prevalent in obstetric patients, usually characterized by a postural headache. PDPH is hypothesized to result from cerebrospinal fluid leakage through a dural puncture, triggering symptoms like neck stiffness and subjective hearing changes. While conservative measures are common for treatment, more refractory cases may require invasive interventions such as an epidural blood patch (EBP). Recent studies have shown promise in using nebulized dexmedetomidine (nDEX) for PDPH, offering a non-invasive alternative to EBP. Two case presentations illustrate the efficacy of nDEX in resolving PDPH symptoms rapidly and completely. These cases underscore the need for exploring novel therapeutic options, especially in obstetric patients where safe and prompt relief is essential for maternal and newborn well-being. While the EBP remains the gold standard, its limitations of accessibility and invasiveness highlight the significance of investigating alternatives like nDEX.
硬膜穿刺后头痛（PDPH）是神经轴索麻醉的一种使人衰弱的并发症，在产科患者中尤为常见，通常表现为体位性头痛。据推测，PDPH是由脑脊液通过硬膜穿刺漏出引起的，会引发颈部僵硬和主观听力变化等症状。虽然保守治疗措施很常见，但更难治的病例可能需要硬膜外血贴（EBP）等侵入性干预措施。最近的研究表明，雾化右美托咪定（nDEX）用于治疗PDPH有前景，为EBP提供了一种非侵入性替代方法。两个病例展示了nDEX在快速、完全缓解PDPH症状方面的疗效。这些病例强调了探索新治疗选择的必要性，特别是在产科患者中，安全、迅速缓解症状对母婴健康至关重要。虽然EBP仍然是金标准，但其可及性和侵入性的局限性凸显了研究nDEX等替代方法的重要性。
