Evidence-Based Prevention and Treatment of Post-dural Puncture Headache for Parturient Women_Chinese Journal of Evidence-Based Medicine

Authors：

TANG Yuying ,  LIN Xuemei , HUANG Wei

Department of Anesthesiology, West China Second University Hospital, Sichuan University, Chengdu 610041 , China;

Corresponding author：

LIN Xuemei, Email: lxm0301@sina.com

Keywords：

Post-dural puncture headache; Parturient women; Evidence-based prevention and treatment

Video：

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Objective 　To evaluate the evidence-based prevention and treatment of post-dural puncture headache (PDPH) for parturient women.
Methods 　We searched The Cochrane Library (Issue 3, 2006), Medline (Jan. 1980 to Oct. 2006) and CBM-disc (Jan. 1980 to Oct. 2006) to identify current best evidence on the prevention and treatment of PDPH for parturient women. The quality of available evidence was critically appraised.
Results 　We identified 2 Cochrane systematic reviews, 2 meta-analyses and 9 randomized controlled trials. Evidence indicated that posture, fluid, and pharmacological managements had no significant effect on PDPH except epidural blood patch. The selection of appropriate spinal needle and the technique of needle insertion may reduce the incidence of PDPH, whereas the effect of intrathecal saline infusion and catheter insertion need further clinical validation.
Conclusions 　Epidural blood patch has definite therapeutic effect on PDPH. Appropriate spinal needle and insertion technique may effectively prevent PDPH for parturient women.

Citation： TANG Yuying,LIN Xuemei,HUANG Wei. Evidence-Based Prevention and Treatment of Post-dural Puncture Headache for Parturient Women. Chinese Journal of Evidence-Based Medicine, 2007, 07(3): 226-229. doi: Copy

1.	Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth, 2003, 50(5): 460–469.
2.	Naulty JS, Hertwig L, Hunt CO, et al. Influence of local anesthetic solution on postural puncture headache. Anesthesiology, 1990, 72(3): 450–454.
3.	Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology, 2003, 17(3): 451–469.
4.	Sudlow C, Warlow C. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev, 2002, 2:CD001790.
5.	Sudlow C, Warlow C. Epidural blood patching for preventing and treating post-dural puncture headache. The Cochrane Database of Systematic Reviews 2006 Issue 3.
6.	Richman JM, Joe EM, Cohen SR. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist, 2006, 12(4): 224–228.
7.	Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai, 2006, 89(6): 814–820.
8.	Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth, 1992, 17(1): 34–36.
9.	Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on post-dural puncture headache: a double-blind, placebo-controlled trial. Anaesthesia and analgesia, 1990, 70(2): 181–184.
10.	Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg, 2005, 56(3): 265–269.
11.	Landau R, Ciliberto CF, Goodman SR, et al. Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. International Journal of Obstetric Anesthesia, 2001, 10(3): 168–171.
12.	Douglas MJ, Ward ME, Campbell DC, et al. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. International Journal of Obstetric Anesthesia, 1997, 6(4): 220–223.
13.	Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
14.	Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med, 2001, 26(4): 301–305.
15.	Sabry Ayad, Yousef Demian, Samer N, et al. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Regional Anesthesia and Pain Medicine, 2003, 28(6): 512–515.
16.	erger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth, 1998, 45(2): 110–114.
17.	Connelly NR, Parker RK, Rahimi A, et al. Sumatriptan in patients with postdural puncture headache. Headache, 2000, 40: 316–319.
18.	Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
19.	Wu YW, Hui YL, Tan PP. Experience of epidural blood patch for post-dural puncture headache. Acta Anaesthesiol Sin, 1994, 32(2): 137–140.
20.	Williams EJ, Beaulieu P, Fawcett WJ. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth, 1999, 8(2): 105–109.
21.	Pamela J. Angle, Kamal Hussain, Anwar Morgan, et al. High quality labour analgesia using small gauge epidural needles and catheters. Can J Anesth, 2006, 53(3): 263–267.
22.	Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand, 2003, 47(1): 98–100.
23.	Cohen S, Pollak P. Caudal saline infusion treatment for post dural puncture headache. Int J Obstet Anesth, 2001, 10(2): 149–150.

1. Choi PT, Galinski SE, Takeuchi L, et al. PDPH is a common complication of neuraxial blockade in parturients: a meta-analysis of obstetrical studies. Can J Anaesth, 2003, 50(5): 460–469.
2. Naulty JS, Hertwig L, Hunt CO, et al. Influence of local anesthetic solution on postural puncture headache. Anesthesiology, 1990, 72(3): 450–454.
3. Candido KD, Stevens RA. Post-dural puncture headache: pathophysiology, prevention and treatment. Best Practice & Research Clinical Anaesthesiology, 2003, 17(3): 451–469.
4. Sudlow C, Warlow C. Posture and fluids for preventing post-dural puncture headache. Cochrane Database Syst Rev, 2002, 2:CD001790.
5. Sudlow C, Warlow C. Epidural blood patching for preventing and treating post-dural puncture headache. The Cochrane Database of Systematic Reviews 2006 Issue 3.
6. Richman JM, Joe EM, Cohen SR. Bevel direction and postdural puncture headache: a meta-analysis. Neurologist, 2006, 12(4): 224–228.
7. Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al. Comparison of prevalence of post-dural puncture headache between six hour- supine recumbence and early ambulation after lumbar puncture in thai patients: A randomized controlled study. J Med Assoc Thai, 2006, 89(6): 814–820.
8. Abboud TK, Zhu J, Reyes A, et al. Effect of subarachnoid morphine on the incidence of spinal headache. Reg Anesth, 1992, 17(1): 34–36.
9. Camann WR, Murray RS, Mushlin PS, et al. Effects of oral caffeine on post-dural puncture headache: a double-blind, placebo-controlled trial. Anaesthesia and analgesia, 1990, 70(2): 181–184.
10. Sandesc D, Lupei MI, Sirbu C, et al. Conventional treatment or epidural blood patch for the treatment of different etiologies of post dural puncture headache. Acta Anaesthesiol Belg, 2005, 56(3): 265–269.
11. Landau R, Ciliberto CF, Goodman SR, et al. Complications with 25-gauge and 27-gauge Whitacre needles during combined spinal-epidural analgesia in labor. International Journal of Obstetric Anesthesia, 2001, 10(3): 168–171.
12. Douglas MJ, Ward ME, Campbell DC, et al. Factors involved in the incidence of post-dural puncture headache with the 25 gauge Whitacre needle for obstetric anesthesia. International Journal of Obstetric Anesthesia, 1997, 6(4): 220–223.
13. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients.International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
14. Charsley MM, Abram SE. The injection of intrathecal normal saline reduces the severity of postdural puncture headache. Reg Anesth Pain Med, 2001, 26(4): 301–305.
15. Sabry Ayad, Yousef Demian, Samer N, et al. Subarachnoid catheter placement after wet tap for analgesia in labor: influence on the risk of headache in obstetric patients. Regional Anesthesia and Pain Medicine, 2003, 28(6): 512–515.
16. erger CW, Crosby ET, Grodecki W. North American survey of the management of dural puncture occurring during labour epidural analgesia. Can J Anaesth, 1998, 45(2): 110–114.
17. Connelly NR, Parker RK, Rahimi A, et al. Sumatriptan in patients with postdural puncture headache. Headache, 2000, 40: 316–319.
18. Paech M, Banks S, Gurrin L. An audit of accidental dural puncture during epidural insertion of a Tuohy needle in obstetric patients. International Journal of Obstetric Anesthesia, 2001, 10(3): 162–167.
19. Wu YW, Hui YL, Tan PP. Experience of epidural blood patch for post-dural puncture headache. Acta Anaesthesiol Sin, 1994, 32(2): 137–140.
20. Williams EJ, Beaulieu P, Fawcett WJ. Efficacy of epidural blood patch in the obstetric population. Int J Obstet Anesth, 1999, 8(2): 105–109.
21. Pamela J. Angle, Kamal Hussain, Anwar Morgan, et al. High quality labour analgesia using small gauge epidural needles and catheters. Can J Anesth, 2006, 53(3): 263–267.
22. Kuczkowski KM, Benumof JL. Decrease in the incidence of post-dural puncture headache: maintaining CSF volume. Acta Anaesthesiol Scand, 2003, 47(1): 98–100.
23. Cohen S, Pollak P. Caudal saline infusion treatment for post dural puncture headache. Int J Obstet Anesth, 2001, 10(2): 149–150.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Prevention and Treatment of Post-dural Puncture Headache for Parturient Women

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