TY - JOUR
T1 - Management practices for postdural puncture headache in obstetrics: a prospective, international, cohort study
AU - EPiMAP collaboration
AU - Gupta, Anil
AU - von Heymann, Christian
AU - Magnuson, Anders
AU - Alahuhta, Seppo
AU - Fernando, Roshan
AU - van de Velde, Marc
AU - Mercier, Frédéric J.
AU - Schyns-van den Berg, Alexandra M. J. V.
AU - Isabelle, Casier
AU - Bart, Bryon
AU - Filiep, Soetens
AU - Pierre-Yves, Dewandre
AU - Geraldine, Lambert
AU - Jan, Christiaen
AU - Roel, Schepers
AU - Patrick, Van H.
AU - Alain, Kalmar
AU - Henk, Vanoverschelde
AU - Monique, Bauters
AU - Eva, Roofthooft
AU - the EPiMAP collaborators
AU - Ana, Jadrijevic
AU - Aleksandra, Jokic
AU - Damjan, Marin
AU - Ivan, Sklebar
AU - Slobodan, Mihaljević
AU - Martina, Kosinova
AU - Petr, Stourac
AU - Milan, Adamus
AU - Christian, Kufa
AU - Ivana, Volfová
AU - Blažena, Zaoralová
AU - Christina, Froeslev-Friis
AU - Bjoern, Mygil
AU - Charlotte, Krebs Albrechtsen
AU - Tomi, Kavasmaa
AU - Seppo, Alahuhta
AU - Anne, M. yrä
AU - Susanna, Mennander
AU - Kati, Rautaneva
AU - Tuula, Hiekkanen
AU - Vesa, Kontinen
AU - Kirsti, Linden
AU - Sara, Toivakka
AU - Emmanuel, Boselli
AU - Pierre-Édouard, Greil
AU - Olivier, Mascle
AU - Aurelie, Courbon
AU - Jean, Lutz
AU - Thérèse, Simonet
AU - Hollmann, Markus W.
PY - 2020/12
Y1 - 2020/12
N2 - Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
AB - Background: Accidental dural puncture is an uncommon complication of epidural analgesia and can cause postdural puncture headache (PDPH). We aimed to describe management practices and outcomes after PDPH treated by epidural blood patch (EBP) or no EBP. Methods: Following ethics committee approval, patients who developed PDPH after accidental dural puncture were recruited from participating countries and divided into two groups, those receiving EBP or no EBP. Data registered included patient and procedure characteristics, headache symptoms and intensity, management practices, and complications. Follow-up was at 3 months. Results: A total of 1001 patients from 24 countries were included, of which 647 (64.6%) received an EBP and 354 (35.4%) did not receive an EBP (no-EBP). Higher initial headache intensity was associated with greater use of EBP, odds ratio 1.29 (95% confidence interval 1.19–1.41) per pain intensity unit increase. Headache intensity declined sharply at 4 h after EBP and 127 (19.3%) patients received a second EBP. On average, no or mild headache (numeric rating score≤3) was observed 7 days after diagnosis. Intracranial bleeding was diagnosed in three patients (0.46%), and backache, headache, and analgesic use were more common at 3 months in the EBP group. Conclusions: Management practices vary between countries, but EBP was more often used in patients with greater initial headache intensity. EBP reduced headache intensity quickly, but about 20% of patients needed a second EBP. After 7 days, most patients had no or mild headache. Backache, headache, and analgesic use were more common at 3 months in patients receiving an EBP.
KW - accidental dural puncture
KW - epidural analgesia
KW - epidural blood patch
KW - obstetrics
KW - postdural puncture headache
UR - http://www.scopus.com/inward/record.url?scp=85092228820&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.bja.2020.07.061
DO - https://doi.org/10.1016/j.bja.2020.07.061
M3 - Article
C2 - 33039123
SN - 0007-0912
VL - 125
SP - 1045
EP - 1055
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 6
ER -