Seeberger M D, Kaufmann M, Staender S, Schneider M, Scheidegger D
Department of Anaesthesia, University of Basel, Kantonsspital, Switzerland.
Anesth Analg. 1996 Feb;82(2):302-5. doi: 10.1097/00000539-199602000-00015.
Previous studies have failed to find a significant correlation between the number of dural punctures and the incidence of postdural puncture headache (PDPH), questioning the hypothesis that leakage of cerebrospinal fluid (CSF) through the dural tear is the cause of PDPH. We hypothesized that insufficient statistical power of these studies was the cause for this unexpected finding, and re-examined whether repeated dural punctures increase the incidence of PDPH by analyzing prospectively collected data on 8034 spinal anesthetics. Uneventful spinal anesthetics, including a single subarachnoid injection of local anesthetics, occurred in 7865 (97.9%) cases, whereas failed spinal anesthetics requiring repeated dural puncture for a second subarachnoid injection of local anesthetics occurred in 165 (2.1%) cases. The two groups were similar with regard to age, sex, and ASA physical status. We found that repeated dural punctures significantly increased the incidence of PDPH. We conclude that increased risk of PDPH is a disadvantage of performing a second subarachnoid injection of local anesthetics after a failed spinal anesthetic. Moreover, this result suggests that leakage of CSF through the dural tear is the most plausible cause of PDPH.
以往的研究未能发现硬膜穿刺次数与硬膜穿刺后头痛（PDPH）发生率之间存在显著相关性，这对脑脊液（CSF）通过硬膜撕裂处漏出是PDPH病因这一假说提出了质疑。我们推测这些研究的统计效力不足是导致这一意外发现的原因，并通过分析前瞻性收集的8034例脊髓麻醉数据，重新审视了重复硬膜穿刺是否会增加PDPH的发生率。7865例（97.9%）患者接受了顺利的脊髓麻醉，包括单次蛛网膜下腔注射局部麻醉药；而165例（2.1%）患者脊髓麻醉失败，需要重复硬膜穿刺以便进行第二次蛛网膜下腔注射局部麻醉药。两组在年龄、性别和美国麻醉医师协会（ASA）身体状况方面相似。我们发现重复硬膜穿刺显著增加了PDPH的发生率。我们得出结论，PDPH风险增加是脊髓麻醉失败后进行第二次蛛网膜下腔注射局部麻醉药的一个不利因素。此外，这一结果表明脑脊液通过硬膜撕裂处漏出是PDPH最合理的病因。
