Edwards Wesley, Chow Lorraine, Zaphiratos Valerie
Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Anesthesiology, Perioperative and Pain Medicine, Alberta Health Services and University of Calgary, Calgary, AB, Canada.
Can J Anaesth. 2025 Jul;72(7):1163-1178. doi: 10.1007/s12630-025-03013-2. Epub 2025 Jul 22.
In this Continuing Professional Development module, we review the literature on postdural puncture headache (PDPH) in obstetrics. The pathophysiology, risk factors, diagnosis, and outcomes are discussed. We explore the evidence for prevention and treatment options of PDPH in obstetric patients and the importance of the anesthesiologist's role in caring for these patients.
A PDPH is any headache that develops after a dural puncture and is not better accounted for by another diagnosis. Risk factors for PDPH include young age and female sex, which, along with the high rate of neuraxial anesthesia use in the obstetric population, predispose these patients to this complication. A spinal anesthesia technique using a small-gauge pencil-point needle with an experienced operator decreases the risk of PDPH. Individuals with PDPH have an increased risk of major neurologic complications, such as subdural hematoma, cerebral venous sinus thrombosis, and bacterial meningitis. No pharmacological modalities have shown a benefit in preventing or treating PDPH. Epidural blood patch remains the most effective treatment for PDPH and should not be delayed in obstetric patients with severe symptoms.
Postpartum individuals cope with recovering from birth in addition to the demands of caring for a newborn. Often, the addition of a PDPH is incapacitating. Epidural blood patch should not be delayed in patients with early and severe symptoms. All individuals who experience PDPH should be assessed, receive appropriate treatment, and be reviewed by a member of the anesthesia team until symptoms have resolved, with appropriate follow-up instructions before discharge.
在本继续职业发展模块中，我们回顾了关于产科硬膜穿刺后头痛（PDPH）的文献。讨论了其病理生理学、危险因素、诊断及预后。我们探讨了产科患者PDPH预防和治疗方案的证据以及麻醉医生在护理这些患者中所起作用的重要性。
PDPH是硬膜穿刺后出现的任何头痛，且不能用其他诊断更好地解释。PDPH的危险因素包括年轻和女性，再加上产科人群中较高的神经轴索麻醉使用率，使这些患者易发生这种并发症。使用小号笔尖针且由经验丰富的操作者进行脊髓麻醉技术可降低PDPH的风险。PDPH患者发生重大神经并发症（如硬膜下血肿、脑静脉窦血栓形成和细菌性脑膜炎）的风险增加。尚无药物治疗方法在预防或治疗PDPH方面显示出益处。硬膜外血贴仍然是治疗PDPH最有效的方法，对于有严重症状的产科患者不应延迟使用。
产后个体除了要应对照顾新生儿的需求外，还要从分娩中恢复。通常，PDPH的出现会使人丧失能力。对于有早期严重症状的患者，不应延迟硬膜外血贴治疗。所有发生PDPH的个体都应接受评估、接受适当治疗，并由麻醉团队成员进行复查，直至症状缓解，出院前给予适当的随访指导。
