脊髓和硬膜外麻醉后体位性硬膜穿刺后头痛。一项随机双盲研究。
Postural post-dural puncture headache after spinal and epidural anaesthesia. A randomised, double-blind study.
作者信息
Flaatten H, Felthaus J, Larsen R, Bernhardsen S, Klausen H
机构信息
Department of Anaesthesiology, Haukeland University Hospital, Bergen, Norway.
出版信息
Acta Anaesthesiol Scand. 1998 Aug;42(7):759-64. doi: 10.1111/j.1399-6576.1998.tb05318.x.
BACKGROUND
This study was conducted in order to investigate the effect of patient expectation in the development of postural post-dural puncture headache (PPDPH).
METHODS
224 patients less than 55 years scheduled for minor non-obstetric surgery were randomised to receive single-injection spinal (SA) or epidural (EA) anaesthesia. A 27-g Quinke needle was used for SA and a 18-g Tuohy needle for EA. Patients, operating team and postoperative ward personnel were all blinded to the anaesthetic given and so was an independent observer responsible for follow-up after 5-7 days. The occurrence of headache, backache and other complaints was recorded. Headache was classified as PPDPH or non-PPDPH, and duration and intensity of the headache was registered. The quality of anaesthesia was directly evaluated by the surgeon using a VAS scale from 1 (excellent) to 10 (very poor) and indirectly by the supplemental use of opioid analgesia and general anaesthesia in the two groups.
RESULTS
212 patients, 103 SA and 109 EA, with a mean age of 36.7 years, could be fully evaluated. The groups were comparable with regards to age, sex and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 16 patients (15.5%) in the SA group and 2 (1.8%) in the EA group (P = 0.0014). Non-PPDPH occurred in 13 patients in each group. PPDPH had significantly greater mean intensity and duration than non-PPHPH. More patients in the EA group had postoperative backache (31.2%) than in the SA group (22.3%), but this difference was not statistically significant. More patients in the EA received general anaesthesia and opioid analgesia than in the SA group, and the surgeon's rating was on average 1.3 in the SA group compared to 2.5 in the EA group (P = 0.0003).
CONCLUSIONS
SA gave more headache but superior quality of surgical anaesthesia compared with EA. Dural puncture, and not expectation, is the major cause of PPDPH.
背景
本研究旨在调查患者期望在体位性硬膜穿刺后头痛（PPDPH）发生过程中的作用。
方法
将224例年龄小于55岁、计划行非产科小手术的患者随机分为接受单次脊麻（SA）或硬膜外麻醉（EA）。SA采用27G Quinke针，EA采用18G Tuohy针。患者、手术团队及术后病房工作人员均对所给予的麻醉不知情，负责5至7天后随访的独立观察者也不知情。记录头痛、背痛及其他不适的发生情况。头痛分为PPDPH或非PPDPH，并记录头痛的持续时间和强度。外科医生使用1（优秀）至10（非常差）的视觉模拟评分（VAS）量表直接评估麻醉质量，两组中通过补充使用阿片类镇痛药和全身麻醉间接评估麻醉质量。
结果
212例患者（103例SA和109例EA），平均年龄36.7岁，可进行全面评估。两组在年龄、性别及所施行的手术方面具有可比性。术后44例患者出现头痛。SA组16例（15.5%）被诊断为PPDPH，EA组2例（1.8%）（P = 0.0014）。每组各有13例患者发生非PPDPH。PPDPH的平均强度和持续时间显著长于非PPDPH。EA组术后背痛的患者（31.2%）多于SA组（22.3%），但差异无统计学意义。EA组接受全身麻醉和阿片类镇痛药的患者多于SA组，SA组外科医生的评分平均为1.3，而EA组为2.5（P = 0.0003）。
结论
与EA相比，SA导致更多头痛，但手术麻醉质量更佳。硬膜穿刺而非期望是PPDPH的主要原因。
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