Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports

Abstract

Purpose: To describe a bibliographic database on the literature of postdural puncture headache (PDPH) in the obstetrical population, to describe the research architecture in this field, and to evaluate the quality of case-control studies, cohort studies, and controlled clinical trials on PDPH.Methods: Computerized bibliographic searches, citation review, and hand searches were conducted to find all relevant citations on incidence, clinical course, prevention, or treatment of PDPH in parturients. The study design and topic(s) covered by each study were evaluated. Case-control studies and cohort studies were evaluated using the Quality Index; clinical trials were evaluated using the Jadad scale.Results: One hundred ninety-six relevant citations were published between 1949 and 1999. Research on PDPH has been increasing rapidly with the majority of studies published in the 1990's. Incidence and prevention were the focus of over half of all citations. Optimal study designs were infrequently utilized. The methodological quality was poor for observational studies (Quality Index 10/29) and clinical trials (Jadad scale 2/5).Conclusion: Although the amount of research on PDPH in parturients is increasing, use of optimal study designs and improvement in methodology is needed.

The management of accidental dural puncture and postdural puncture headache: a North American survey

“…However, respondents to our survey also reported using some conservative measures frequently despite little evidence of efficacy, a finding similar to what has been reported in other surveys. Little evidence supports the use of oral or IV hydration in reducing the incidence of PDPH [21][22][23] or the effectiveness of oral NSAIDs or opioid administration [24]. Bed rest does not appear to affect the course of PDPH [22,23].…”

Expectant management of postdural puncture headache increases hospital length of stay and emergency room visits

“…While prophylactic EBP is likely to be associated with risks, expectant management is also likely to be associated with "costs" of its own including additional use of health resources and importantly, human costs related to maternal quality of life and effects on maternal-infant bonding. Unfortunately, the overall quality of the literature related to PDPH is poor 13 and the relative risks and benefits of prophylactic vs therapeutic EBP remain unclear. 14 Our study examined length of hospital stay and ER visits attributable to expectant management of PDPH in women with recognized DP during epidural placement.…”

PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies

“…4 The literature search was repeated in , citation review, and hand searches of abstracts and proceedings of major anesthesia conferences. Any citation, regardless of study design and language, was included in this review if it contained extractable data on frequency, onset, or duration of PDPH.…”

“…Suggestions for improvement have been reported previously. 4 Attempts to determine the onset and duration of PDPH highlight the challenges and limitations of pooling data. Pooling requires data to be converted into discrete forms (e.g., proportions), continuous forms (e.g., means) or similar probabilities (e.g., P values).…”