Kroegel S, von Heymann C, Schyns-van den Berg A, Becke K, Kranke P, Lewald H, Müller S, Muggleton E, Neumann C, Ohnesorge H, Piper S, Kaufner L
Klinik für Anästhesiologie und Intensivmedizin CCM/CVK, Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland.
Anaesthesiologie. 2025 Jun;74(6):362-371. doi: 10.1007/s00101-025-01540-7. Epub 2025 May 21.
Accidental dural puncture (ADP) is a rare but serious complication that can lead to post-dural puncture headache (PDPH), a condition known to significantly impair the well-being of affected women.
The present study examines the patient characteristics, symptoms, management and outcomes of women with PDPH after ADP and focuses on differences between conservative management and epidural blood patch (EBP).
The data of nine German study sites of the European prospective, multicenter cohort EPIMAP (European Practice in the Management of Accidental Dural Puncture in Obstetrics) trial were analyzed. Only descriptive analyses were performed due to the small sample size.
Data were collected between 2016 and 2018 and 73 patients were included in Germany. Of the 73 patients (76.7%), 56 received an EBP and 17 were treated conservatively (23.3%). In the conservative treatment group, the median numeric rating score of pain (NRS) plus interquartile range (IQR) during the hospital stay was 2 (1; 3) at rest and 7 (5; 8) while sitting or standing. Upon discharge, the NRS had decreased to 0 (0; 1) at rest and 2 (1; 4) while sitting or standing. In the EBP group NRS was 3 (1; 7) at rest and 8.5 (7; 10) while sitting or standing 6-12 h before the intervention. Furthermore, 24 h after the EBP, NRS was 0 (0; 2) at rest and 1 (0; 2) while sitting or standing. A total of 15 women were readmitted to the hospital for recurrent PDPH after EBP (26.8%). A second EBP was administered to 9 patients (60%).
The EBP is an effective treatment option for post-puncture dural headache. The choice between the EBP and a conservative treatment seems to be influenced by the intensity of the PDPH. These results underline the importance of an individual treatment approach in patients with PDPH.
意外硬膜穿破（ADP）是一种罕见但严重的并发症，可导致硬膜穿刺后头痛（PDPH），这种情况已知会显著损害受影响女性的健康。
本研究调查了ADP后发生PDPH的女性患者的特征、症状、治疗及结局，并重点关注保守治疗与硬膜外血贴（EBP）之间的差异。
分析了欧洲前瞻性多中心队列EPIMAP（欧洲产科意外硬膜穿破管理实践）试验中9个德国研究地点的数据。由于样本量小，仅进行了描述性分析。
数据收集于2016年至2018年期间，德国纳入了73例患者。在这73例患者中（76.7%），56例接受了EBP治疗，17例接受了保守治疗（23.3%）。在保守治疗组中，住院期间静息时疼痛数字评分量表（NRS）的中位数加上四分位数间距（IQR）为2（1；3），坐或站时为7（5；8）。出院时，静息时NRS降至0（0；1），坐或站时为2（1；4）。在EBP组中，干预前6 - 12小时静息时NRS为3（1；7），坐或站时为8.5（7；10）。此外，EBP后24小时，静息时NRS为0（0；2），坐或站时为1（0；2）。共有15名女性在EBP后因复发性PDPH再次入院（26.8%）。9例患者（60%）接受了第二次EBP治疗。
EBP是穿刺后硬膜头痛的一种有效治疗选择。EBP与保守治疗之间的选择似乎受PDPH严重程度的影响。这些结果强调了PDPH患者个体化治疗方法的重要性。
