Evidence-based clinical practice guidelines on postdural puncture headache: a consensus report from a multisociety international working group

Abstract

IntroductionPostdural puncture headache (PDPH) can follow unintentional dural puncture during epidural techniques or intentional dural puncture during neuraxial procedures such as a lumbar puncture or spinal anesthesia. Evidence-based guidance on the prevention, diagnosis or management of this condition is, however, currently lacking. This multisociety guidance aims to fill this void and provide practitioners with comprehensive information and patient-centric recommendations to prevent, diagnose and manage patients with PDPH.MethodsBased on input from committee members and stakeholders, the committee cochairs developed 10 review questions deemed important for the prevention, diagnosis and management of PDPH. A literature search for each question was performed in MEDLINE (Ovid) on 2 March 2022. The results from each search were imported into separate Covidence projects for deduplication and screening, followed by data extraction. Additional relevant clinical trials, systematic reviews and research studies published through March 2022 were also considered for the development of guidelines and shared with contributors. Each group submitted a structured narrative review along with recommendations graded according to the US Preventative Services Task Force grading of evidence. The interim draft was shared electronically, with each collaborator requested to vote anonymously on each recommendation using two rounds of a modified Delphi approach.ResultsBased on contemporary evidence and consensus, the multidisciplinary panel generated 50 recommendations to provide guidance regarding risk factors, prevention, diagnosis and management of PDPH, along with their strength and certainty of evidence. After two rounds of voting, we achieved a high level of consensus for all statements and recommendations. Several recommendations had moderate-to-low certainty of evidence.ConclusionsThese clinical practice guidelines for PDPH provide a framework to improve identification, evaluation and delivery of evidence-based care by physicians performing neuraxial procedures to improve the quality of care and align with patients’ interests. Uncertainty remains regarding best practice for the majority of management approaches for PDPH due to the paucity of evidence. Additionally, opportunities for future research are identified.

Cefaleia Pós-Punção Dural Em Raquianestesia: Uma Revisão Bibliográfica Sobre Incidência, Fatores De Risco E Estratégias De Manejo

“…Estudos demonstram que a implementação de estratégias preventivas pode reduzir os custos associados à CPPD (Uppal et al, 2023). Por exemplo, o uso de agulhas com ponta de lápis, apesar de inicialmente mais caras, pode resultar em economia significativa ao reduzir a incidência de CPPD e a necessidade de tratamentos subsequentes (Schmittner et al, 2010).…”

“…A análise econômica das estratégias de prevenção e manejo da CPPD pode fornecer informações valiosas para a tomada de decisão em políticas de saúde (Oberhofer et al, 2013). Investir em práticas preventivas eficazes não só melhora a saúde dos pacientes, mas também pode levar a uma utilização mais eficiente dos recursos de saúde (Uppal et al, 2023).…”

Intranasal Lidocaine Administration via Mucosal Atomization Device: A Simple and Successful Treatment for Postdural Puncture Headache in Obstetric Patients

“…Low effectiveness for conservative measures, including hydration, bed rest, analgesics, or caffeine has been reported [10]. If conservative treatments do not result in a timely relief of symptoms, current guidelines recommend the implementation of an autologous epidural blood patch (EBP) [16,17]. With success rates between 77 and 96% [18], the EBP represents the current gold standard in PDPH therapy.…”

Estado actual de la cefalea postpunción meníngea en un hospital colombiano

“…La cefalea postpunción meníngea (CPPM) es una de las complicaciones más frecuentes, considerada una complicación menor, que se presenta en pacientes sometidos a punción lumbar, ya sea diagnóstica o terapéutica, y procedimientos que requieren anestesia raquídea (4). Se han establecido factores de riesgo como la edad, si se trata de una paciente obstétrica, un índice de masa corporal bajo, la posición del paciente para la punción, el tamaño y el tipo de aguja espinal utilizada (5)(6)(7)(8)(9)(10).…”