Punção Acidental da Dura e Cefaleia Pós-punção da Dura na População Obstétrica: Oito Anos de Experiência

Antunes, M.; Moreira, Adriano; Sampaio, Catarina; Faria, A.

doi:10.20344/amp.6815

Cited by 3 publications

(4 citation statements)

References 35 publications

(60 reference statements)

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“…The difference in incidence of PDPH is small between the groups. Several studies that only included a small size population failed to detect a difference in the incidence of PDPH [12, 15, 18], while our meta-analysis of 13 studies with 1044 patients observed a significant difference. Even when our retrospective study was included in the meta-analysis, we found similar results (PDPH: pooled RR = 0.814, 95% CI = 0.698–0.950, P = 0.009; TEBP: pooled RR = 0.608, 95% CI = 0.451–0.819, P = 0.001).…”

Section: Discussioncontrasting

confidence: 52%

“…In our systematic literature review, 221 articles were initially identified and 13 studies including 1044 obstetric patients were finally included in the meta-analysis [1, 3, 8–18]. Fig 1 shows the selection process for eligible studies.…”

Section: Resultsmentioning

confidence: 99%

“…Although this meta-analysis included nine reports, among them, three were abstracts of a conference, and they were not published at full length. Since the last meta-analysis was performed, several relevant studies have been published [1, 3, 8, 13, 14, 18]. Most interestingly, Verstraete et al [8] and Kaddoum et al [13] both reported that the application of intrathecal catheter following ADP reduced the risk of PDPH in obstetric patients.…”

Section: Discussionmentioning

confidence: 99%

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Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: A retrospective study and meta-analysis

et al. 2017

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This study aimed to determine whether insertion of an intrathecal catheter following accidental dural puncture (ADP) in obstetric patients can reduce the incidence of post-dural puncture headache (PDPH) and the requirement of a therapeutic epidural blood patch (TEBP). This was also compared with relocating the epidural catheter at a different vertebral interspace. A retrospective study was performed, as well as a meta-analysis of the literature to further validate our findings. We reviewed the records of 86 obstetric patients who suffered from ADP during epidural anesthesia or combined spinal-epidural anesthesia from October 2015 to November 2016 at our institution. Although, there was no significant decrease in the incidence of PDPH (P = 0.08), the requirement for a TEBP (P = 0.025) was significantly reduced in the intrathecal catheter group compared with the relocated group. In the meta-analysis, 13 eligible studies including 1044 obstetric patients were finally identified. To estimate the pooled risk ratios (RRs), fixed or random effect models were used depending on the heterogeneity. We initially found that an intrathecal catheter significantly reduced the incidence of PDPH (pooled RR = 0.823; 95% CI = 0.700–0.967; P = 0.018) and the requirement of a TEBP (pooled RR = 0.616; 95% CI = 0.443–0.855; P = 0.004). Our study shows that insertion of an intrathecal catheter following ADP might be an effective and dependable method for reducing the risk of a PDPH and requirement for a TEBP in obstetric patients.

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Section: Discussioncontrasting

confidence: 52%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: A retrospective study and meta-analysis

et al. 2017

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“…[ 1 ] The prevalence of PDPH is higher in pregnant women,[ 1 ] and extensive data are available on incidence, management and prevention of PDPH in obstetric patient both following spinal anaesthesia (SA) and accidental dural puncture (ADP) during epidural analgesia (EA). [ 2 ],[ 3 ],[ 4 ],[ 5 ],[ 6 ] The incidence of PDPH following ADP varies and can be 80–86% in the obstetric population. [ 2 ]…”

Section: Introductionmentioning

confidence: 99%

Incidence and management of post-dural puncture headache following spinal anaesthesia and accidental dural puncture from a non-obstetric hospital: A retrospective analysis

Bakshi

Gehdoo

2018

Indian J Anaesth

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Background and Aims:Post-dural puncture headache (PDPH) is one of the complications following spinal anaesthesia (SA) and accidental dural puncture (ADP). In our institute, we routinely practice epidural analgesia (EA) for supra-major surgeries. Our previous audit on EA revealed 4% incidence of ADP. This lead us to a clinical initiative to follow-up patients with dural puncture (DP) to note the incidence, presentation, associated symptoms and treatment of PDPH. Herewith, we present the retrospective analysis over a 2-year period.Methods:Following institutional review board approval, the follow-up notes of patients who had DP from May 2011 to April 2013 were analysed retrospectively (using SPSS 20 version) with respect to the needle size, level of DP, reinsertion of epidural catheter, details of ongoing analgesics, incidence and severity of PDPH and treatment received.Results:In 2 years, we found that the incidence of PDPH in the patients who received SA was 3.9% and 25% in the ADP group. There was a positive association between needle size, type and PDPH, and it was seen more in the 20–40 age group. The commonest presentation of PDPH was occipital/frontal headache within 96 h and lasted for a mean of 3 days. All patients received pharmacological treatment. Seventy-one per cent of patients (25) were either on coffee or caffeine tablets. One case of intractable PDPH responded well to oral pregabalin 75 mg.Conclusion:PDPH severity and incidence following ADP in our centre is lower than the reported incidence from obstetric centres and can be effectively controlled with drug treatment only.

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Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis

Creazzola,

Aversano,

Prencipe

et al. 2023

J Anesth Analg Crit Care

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Background Accidental dural puncture is a common complication of labour analgesia. It can trigger post-dural puncture headache, with associated morbidity and increased costs. Intrathecal catheter placement is a prophylactic procedure which can reduce incidence and severity of post-dural puncture headache. Methods We conducted a retrospective single-centred study to define incidence and risk factors of accidental dural puncture and post-dural puncture headache in an obstetric population. We also evaluated effectiveness of intrathecal catheter placement compared to epidural catheter replacement in reducing incidence of post-dural puncture headache. We then conducted a systematic review and meta-analysis which included all studies comparing intrathecal catheter placement to epidural catheter replacement in obstetric patients with accidental dural puncture assessing the outcome of reduced incidence of post-dural puncture headache as a dichotomous variable. Results Accidental dural puncture had an incidence of 0.25% (60 cases). Of these, 66% developed post-dural puncture headache. A total of 77% (47/60) of patients with accidental dural puncture were treated with an intrathecal catheter placement, while 23% (13/60) had an epidural catheter replacement. Incidence of post-dural puncture headache was lower in the intrathecal catheter group (spinal 26/47, 60.5% epidural 11/13, 84.6%), although not reaching statistical significance (RR 0.71, CI 95%: 0.51–1.00; p = 0.049). The meta-analysis revealed that intrathecal catheter placement significantly reduced incidence of post-dural puncture headache compared to epidural catheter replacement (pooled RR 0.81, 95% CI 0.72–0.91, p < 0.001). Conclusions Intrathecal catheter placement is a promising measure to prevent post-dural puncture headache, especially if followed by a pain management protocol and a continuous saline infusion.

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Punção Acidental da Dura e Cefaleia Pós-punção da Dura na População Obstétrica: Oito Anos de Experiência

Abstract: The incidence of accidental dural puncture and post-dural puncture headache was similar to the literature. Despite being a common complication, there remains lack of consensus on its approach.

Cited by 3 publications

References 35 publications

Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: A retrospective study and meta-analysis

Insertion of an intrathecal catheter in parturients reduces the risk of post-dural puncture headache: A retrospective study and meta-analysis

Incidence and management of post-dural puncture headache following spinal anaesthesia and accidental dural puncture from a non-obstetric hospital: A retrospective analysis

Effective prevention of post-dural puncture headache with insertion of an intrathecal catheter in parturients: a retrospective study and meta-analysis

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